Provider Demographics
NPI:1073512315
Name:LABORATORIO CLINICO SAGRADO CORAZON, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SAGRADO CORAZON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-761-5193
Mailing Address - Street 1:352 AVE SAN CLAUDIO STE 199
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4107
Mailing Address - Country:US
Mailing Address - Phone:787-761-5193
Mailing Address - Fax:787-755-4902
Practice Address - Street 1:370 AVE SAN CLAUDIO
Practice Address - Street 2:URB. SAGRADO CORAZON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4107
Practice Address - Country:US
Practice Address - Phone:787-761-5193
Practice Address - Fax:787-755-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR496291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
31220OtherTRIPLE S, INC
9260064OtherHUMANA HEALTH PLANS, INC
9260064OtherHUMANA INSURANCE , INC
050726OtherLA CRUZ AZUL DE PR
7726OtherINTERNATIONAL MEDICAL CAR
LB00496OtherUNION INDEPENDIENTE AUTEN
400134OtherUNION INDEPENDIENTE TRABA
050726OtherLA CRUZ AZUL DE PR
7726OtherINTERNATIONAL MEDICAL CAR
=========OtherCIGNA
9260064OtherHUMANA HEALTH PLANS, INC
LB00496OtherUNION INDEPENDIENTE AUTEN
9260064OtherHUMANA HEALTH PLANS, INC
9260064OtherHUMANA INSURANCE , INC
400134OtherUNION INDEPENDIENTE TRABA