Provider Demographics
NPI:1235492794
Name:STAT-GENETIK, INC
Entity Type:Organization
Organization Name:STAT-GENETIK, INC
Other - Org Name:HIGH PROFILE LABORATORY II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIPOLL
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-523-1922
Mailing Address - Street 1:PMB 355 EMERALDA AVENUE 405
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4457
Mailing Address - Country:US
Mailing Address - Phone:787-523-1922
Mailing Address - Fax:787-523-1926
Practice Address - Street 1:RAMIREZ DE ARELLANO AVENUE ESQUINA MADRID
Practice Address - Street 2:SHOPPING CENTER TORRIMAR LOCAL 5
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-523-1922
Practice Address - Fax:787-523-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1263291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory