Provider Demographics
NPI:1093708729
Name:LABORATORIO CLINICO SANGERMENO PRINCIPAL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SANGERMENO PRINCIPAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA, MSMT
Authorized Official - Phone:787-892-0635
Mailing Address - Street 1:PO BOX 3008
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-3008
Mailing Address - Country:US
Mailing Address - Phone:787-892-0635
Mailing Address - Fax:787-892-7385
Practice Address - Street 1:9 CALLE PRINCIPAL
Practice Address - Street 2:URB . EL RETIRO
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4447
Practice Address - Country:US
Practice Address - Phone:787-892-0635
Practice Address - Fax:787-892-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR971291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31355OtherSSS
PR1971OtherMCS
PR31191Medicare ID - Type Unspecified