Provider Demographics
NPI:1083664171
Name:LABORATORIO BLASOR INC.
Entity Type:Organization
Organization Name:LABORATORIO BLASOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERENA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-842-6161
Mailing Address - Street 1:8163 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1551
Mailing Address - Country:US
Mailing Address - Phone:787-842-6161
Mailing Address - Fax:787-843-6111
Practice Address - Street 1:8163 CALLE CONCORDIA
Practice Address - Street 2:SUITE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1551
Practice Address - Country:US
Practice Address - Phone:787-842-6161
Practice Address - Fax:787-843-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR104291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30017OtherSSS
PR38042Medicare ID - Type Unspecified