Provider Demographics
NPI:1073583514
Name:LABORATORIO CLINICO VILLA LOS SANTOS
Entity Type:Organization
Organization Name:LABORATORIO CLINICO VILLA LOS SANTOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-879-1609
Mailing Address - Street 1:PO BOX 9091
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9091
Mailing Address - Country:US
Mailing Address - Phone:787-879-1609
Mailing Address - Fax:787-880-3733
Practice Address - Street 1:V1 CALLE 16
Practice Address - Street 2:URB. VILLA LOS SANTOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-3112
Practice Address - Country:US
Practice Address - Phone:787-879-1609
Practice Address - Fax:787-880-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR585291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory