Provider Demographics
NPI:1245230226
Name:LABORATORIO CLINICO IRIZARRY GUASCH
Entity Type:Organization
Organization Name:LABORATORIO CLINICO IRIZARRY GUASCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:
Authorized Official - Last Name:INZARRY GUASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-7222
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0125
Mailing Address - Country:US
Mailing Address - Phone:787-899-7222
Mailing Address - Fax:787-899-2900
Practice Address - Street 1:1 CALLE PROVIDENCIA BARRERO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2146
Practice Address - Country:US
Practice Address - Phone:787-896-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR644291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030855Medicare ID - Type Unspecified
X15444Medicare UPIN