Provider Demographics
NPI:1043283971
Name:LAS LOMAS LABORATORY INC.
Entity Type:Organization
Organization Name:LAS LOMAS LABORATORY INC.
Other - Org Name:LAB. CLINICO LAS LOMAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-792-1824
Mailing Address - Street 1:PO BOX 367027
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7027
Mailing Address - Country:US
Mailing Address - Phone:787-792-1824
Mailing Address - Fax:787-783-6350
Practice Address - Street 1:AVE. JESUS T PINERO ESQ. AVE. SAN PATRICIO LOCAL 32
Practice Address - Street 2:LAS LOMAS PROFESIONAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1489
Practice Address - Country:US
Practice Address - Phone:787-792-1824
Practice Address - Fax:787-783-6350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAS LOMAS LABORATORY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-10
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR374291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400309OtherUTI PREFERRED HEALTH PLAN
PR31498OtherTRIPLE S
PR6578OtherINTERNATIONAL MEDICAL CAR
PR051822OtherLA CRUZ AZUL PR
PR800313OtherMEDICARE Y MUCHO MAS
PR9210002OtherHUMANA INSURANCE
PRLA0304OtherPANAMERICAN LIFE INS
PRLB374OtherUIA
PR6578OtherINTERNATIONAL MEDICAL CAR
PR=========OtherCOVIMED
PR=========OtherMEDICAL CARD SYSTEMS
PR800313OtherMEDICARE Y MUCHO MAS
PR9210002OtherHUMANA INSURANCE
PR30238Medicare ID - Type Unspecified