Provider Demographics
NPI:1033228697
Name:CESAR SANTIAGO
Entity Type:Organization
Organization Name:CESAR SANTIAGO
Other - Org Name:LABORATORIO CLINICO BACTERIOLOGICO BORINQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-882-4700
Mailing Address - Street 1:PO BOX 4249
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4249
Mailing Address - Country:US
Mailing Address - Phone:787-882-4700
Mailing Address - Fax:787-882-4700
Practice Address - Street 1:45 AVE SEVERIANO CUEVAS
Practice Address - Street 2:RPTO. LOPEZ
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5766
Practice Address - Country:US
Practice Address - Phone:787-882-4700
Practice Address - Fax:787-882-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR754291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38288Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER