Provider Demographics
NPI:1063665743
Name:LABORATORIO CLINICO SAN ANTONIO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OMAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-895-4203
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0894
Mailing Address - Country:US
Mailing Address - Phone:787-895-4203
Mailing Address - Fax:787-895-4203
Practice Address - Street 1:ROAD 113 KM 13 6
Practice Address - Street 2:BO SAN ANTONIO
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-0894
Practice Address - Country:US
Practice Address - Phone:787-895-4203
Practice Address - Fax:787-895-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1168291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory