Provider Demographics
NPI:1194829424
Name:ACOSTA ORRACA INC
Entity Type:Organization
Organization Name:ACOSTA ORRACA INC
Other - Org Name:LABORATORIO CLINICO SOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR NOT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGEN M
Authorized Official - Middle Name:VALLE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC#1757
Authorized Official - Phone:787-892-2642
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:LABORATORIO CLINICO SOL
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TETUAN ST #4
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:787-892-2642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR274291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038334Medicare ID - Type Unspecified