Provider Demographics
NPI:1194194944
Name:LABORATORIOS SAN JUAN PSC
Entity Type:Organization
Organization Name:LABORATORIOS SAN JUAN PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-707-1983
Mailing Address - Street 1:PO BOX 51991
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1991
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:429 AVENIDA BARBOSA
Practice Address - Street 2:PLAZA BARBOSA STREAM MALL LOCAL 4
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-0000
Practice Address - Country:US
Practice Address - Phone:787-707-1983
Practice Address - Fax:787-277-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory