Provider Demographics
NPI:1093051393
Name:LABORATORIO SAN RAFAEL QUEBRADILLAS, INC.
Entity Type:Organization
Organization Name:LABORATORIO SAN RAFAEL QUEBRADILLAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-895-2333
Mailing Address - Street 1:109 CALLE SAN CARLOS
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1737
Mailing Address - Country:US
Mailing Address - Phone:787-895-2333
Mailing Address - Fax:
Practice Address - Street 1:109 CALLE SAN CARLOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1737
Practice Address - Country:US
Practice Address - Phone:787-895-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0399291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIC278AMedicare PIN