Provider Demographics
NPI:1093138406
Name:MARIA L CRESPO
Entity Type:Organization
Organization Name:MARIA L CRESPO
Other - Org Name:LABORATORIO CLINICO SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:787-890-6161
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0791
Mailing Address - Country:US
Mailing Address - Phone:787-890-6161
Mailing Address - Fax:787-890-6161
Practice Address - Street 1:1065 AVE GENERAL RAMEY
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690-1117
Practice Address - Country:US
Practice Address - Phone:787-890-6161
Practice Address - Fax:787-890-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR761291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030841Medicare PIN