Provider Demographics
NPI:1093200024
Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Other - Org Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SUPERVISORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-7223
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-7223
Mailing Address - Fax:787-899-1861
Practice Address - Street 1:222 AVENIDA LOS ATLETICOS DE SAN GERMAN
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-0520
Practice Address - Fax:787-264-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory