Provider Demographics
NPI:1043447030
Name:LABORATORIO CLINICO SONIA SEPULVEDA, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SONIA SEPULVEDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT, ACSP
Authorized Official - Phone:787-836-2178
Mailing Address - Street 1:628 PEDRO VELAZQUEZ DIAZ
Mailing Address - Street 2:SUITE B1 EDIFICIO AURORA
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0490
Mailing Address - Country:US
Mailing Address - Phone:787-836-2178
Mailing Address - Fax:787-836-2255
Practice Address - Street 1:STREET 628 PEDRO VELAZQUEZ DIAZ
Practice Address - Street 2:SUITE B1 EDIFICIO AURORA
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-0490
Practice Address - Country:US
Practice Address - Phone:787-836-2178
Practice Address - Fax:787-836-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR347291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38197Medicare PIN