Provider Demographics
NPI:1235479841
Name:LABORATORIO CLINICO MICHELSAN INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MICHELSAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-751-7255
Mailing Address - Street 1:PO BOX 71325
Mailing Address - Street 2:
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:IL32 AVE CARLOS JAVIER ANDALUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2972
Practice Address - Country:US
Practice Address - Phone:787-798-0980
Practice Address - Fax:787-798-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR812291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory