Provider Demographics
NPI:1083793517
Name:EMPRESAS RADIAN, INC.
Entity Type:Organization
Organization Name:EMPRESAS RADIAN, INC.
Other - Org Name:LABORATORIO CLINICO CUPEY GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RADAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLOT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT(ASCP)
Authorized Official - Phone:787-283-1348
Mailing Address - Street 1:# 200, CUPEY GARDENS ST.
Mailing Address - Street 2:PLAZA CUPEY GARDENS, SUITE 4E
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-283-1348
Mailing Address - Fax:787-283-4329
Practice Address - Street 1:# 200, CUPEY GARDENS ST.
Practice Address - Street 2:PLAZA CUPEY GARDENS, SUITE 4E
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-283-1348
Practice Address - Fax:787-283-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1040291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR037409900Medicaid