1821104654 NPI number — LABORATORIO CLINICO HATO ARRIBA

Table of content: MR. ASLAM MOHAMMED KHAJA M.D. (NPI 1003014457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821104654 NPI number — LABORATORIO CLINICO HATO ARRIBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO HATO ARRIBA
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:
1821104654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3175
Provider Second Line Business Mailing Address:
HATO ARRIBA STATION
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-7003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-280-3085
Provider Business Mailing Address Fax Number:
787-280-3085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 111 KM 14 5
Provider Second Line Business Practice Location Address:
PLAZA HATO ARRIBA
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-280-3085
Provider Business Practice Location Address Fax Number:
787-280-3085
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRUZ
Authorized Official First Name:
MAGDALENA
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL SUPERVISOR OWNER
Authorized Official Telephone Number:
787-280-3085

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 1017 , 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: 800330 . This is a "MMM HEALTHCARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20025 . This is a "PREFERRED MEDICARE CHOICE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 32053 . This is a "PROSSAM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0515 . This is a "PALIC NETWORD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 052084 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30902 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6850032 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20223 . This is a "AMERICAN HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400566 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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