1043283971 NPI number — LAS LOMAS LABORATORY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043283971 NPI number — LAS LOMAS LABORATORY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS LOMAS LABORATORY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043283971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00936-7027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-792-1824
Provider Business Mailing Address Fax Number:
787-783-6350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. JESUS T PINERO ESQ. AVE. SAN PATRICIO LOCAL 32
Provider Second Line Business Practice Location Address:
LAS LOMAS PROFESIONAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00921-1489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-792-1824
Provider Business Practice Location Address Fax Number:
787-783-6350
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ-LOPEZ
Authorized Official First Name:
WILSON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-792-1824

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  374 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 400309 . This is a "UTI PREFERRED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 31498 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6578 . This is a "INTERNATIONAL MEDICAL CAR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 051822 . This is a "LA CRUZ AZUL PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800313 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9210002 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0304 . This is a "PANAMERICAN LIFE INS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LB374 . This is a "UIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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