1073512315 NPI number — LABORATORIO CLINICO SAGRADO CORAZON, INC

Table of content: (NPI 1073512315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073512315 NPI number — LABORATORIO CLINICO SAGRADO CORAZON, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO SAGRADO CORAZON, 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:
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:
1073512315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
352 AVE SAN CLAUDIO STE 199
Provider Second Line Business Mailing Address:
URB. SAGRADO CORAZON
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-761-5193
Provider Business Mailing Address Fax Number:
787-755-4902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 AVE SAN CLAUDIO
Provider Second Line Business Practice Location Address:
URB. SAGRADO CORAZON
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00926-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-761-5193
Provider Business Practice Location Address Fax Number:
787-755-4902
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEBRON
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CLINICAL LABORATORY DIRECTOR
Authorized Official Telephone Number:
787-761-5193

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  496 , 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: 31220 . This is a "TRIPLE S, INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9260064 . This is a "HUMANA HEALTH PLANS, INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9260064 . This is a "HUMANA INSURANCE , INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050726 . This is a "LA CRUZ AZUL DE PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7726 . This is a "INTERNATIONAL MEDICAL CAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: LB00496 . This is a "UNION INDEPENDIENTE AUTEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400134 . This is a "UNION INDEPENDIENTE TRABA" identifier . This identifiers is of the category "OTHER".




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