Provider Demographics
NPI:1063634483
Name:LABORATORIO CLINICO DEL SURESTE, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL SURESTE, INC
Other - Org Name:LABORATORIO CLINICO COLON #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YANIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-893-2340
Mailing Address - Street 1:P O BOX 1340
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1340
Mailing Address - Country:US
Mailing Address - Phone:787-893-2340
Mailing Address - Fax:787-893-1112
Practice Address - Street 1:CALLE SATURININO RODRIGUEZ 22
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-1340
Practice Address - Country:US
Practice Address - Phone:787-893-2340
Practice Address - Fax:787-893-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR569291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031566Medicare PIN