Provider Demographics
NPI:1225204506
Name:LABORATORIO DEL SUENO DEL SURESTE INC
Entity Type:Organization
Organization Name:LABORATORIO DEL SUENO DEL SURESTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-864-7339
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1568
Mailing Address - Country:US
Mailing Address - Phone:787-864-7339
Mailing Address - Fax:787-866-4486
Practice Address - Street 1:ASHFORD ST 128 SOUTH
Practice Address - Street 2:ASHFORD MEDICAL PLAZA SUITE 101 B
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-864-7339
Practice Address - Fax:787-866-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9015261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic