1124383773 NPI number — LAVORATORIO CLINICO SAN ANTONIO INC

Table of content: (NPI 1124383773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124383773 NPI number — LAVORATORIO CLINICO SAN ANTONIO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAVORATORIO CLINICO SAN ANTONIO 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:
1124383773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 VILLAS DE SOTOMAYOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUADA
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00602
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-612-7527
Provider Business Mailing Address Fax Number:
787-826-7662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 411 KM 3.0
Provider Second Line Business Practice Location Address:
BARRIO JAGUEY
Provider Business Practice Location Address City Name:
AGUADA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00602-2628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-612-7527
Provider Business Practice Location Address Fax Number:
787-826-7662
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETO
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-612-7527

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1265 , 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: 40D2041381 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1265 . This is a "LICENCIA PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com