Provider Demographics
NPI:1205013935
Name:LABORATORIO CLINICO MICHELSAN INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MICHELSAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-751-7255
Mailing Address - Street 1:PO BOX 71325
Mailing Address - Street 2:SUITE 64
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8425
Mailing Address - Country:US
Mailing Address - Phone:787-751-7255
Mailing Address - Fax:787-274-2283
Practice Address - Street 1:894 CALLE 45 SE
Practice Address - Street 2:AVE AMERICO MIRANDA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1815
Practice Address - Country:US
Practice Address - Phone:787-751-7255
Practice Address - Fax:787-274-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR598291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory