Provider Demographics
NPI:1033167614
Name:HEALTH LABORATORIES SERVICES INC
Entity Type:Organization
Organization Name:HEALTH LABORATORIES SERVICES INC
Other - Org Name:LABORATORIO CLINICO VILLA CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ DE VICTORIA-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-762-4786
Mailing Address - Street 1:PO BOX 3310
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3310
Mailing Address - Country:US
Mailing Address - Phone:787-762-4786
Mailing Address - Fax:787-752-3360
Practice Address - Street 1:ROBERTO CLEMENTE AVENUE BLOCK 89 #2
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-762-4786
Practice Address - Fax:787-752-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR411291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLA-0010OtherPALIC PROVIDER #
PR30299VIOtherTRIPLE S PROV #
PR048755401OtherCOSVI PROV #
PR20115FOtherPMC PROV #
PR400061OtherUTI PREFERRED PROV #
PR6300042OtherHUMANA PROV #
PR800071OtherMMM HEALTHCARE PROV #
PR050562OtherCRUZ AZUL PROV #
PR20095OtherAMERICAN HEALTH PROV #
PR8462OtherIMC PROV #
PR20115FOtherPMC PROV #
PR400061OtherUTI PREFERRED PROV #
PR=========OtherCOSVI MED PROV #
PR=========2OtherMCS REG Y REF PROV #
PR8462OtherIMC PROV #
PR048755401OtherCOSVI PROV #
PR050562OtherCRUZ AZUL PROV #
PR=========02OtherMCS EXCLUSIVE PROV #
PR0038221Medicare ID - Type UnspecifiedPROVIDER NUMBER