Provider Demographics
NPI:1174018089
Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:IRIZARRY GUASCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
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:00667-0593
Mailing Address - Country:US
Mailing Address - Phone:787-899-7223
Mailing Address - Fax:
Practice Address - Street 1:CALLE PERAL ESQUINA DE DIEGO LA PALMA
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-899-7223
Practice Address - Fax:787-899-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory