Provider Demographics
NPI:1255665261
Name:LABORATORIO CLINICO SAN JUAN INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SAN JUAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-756-7128
Mailing Address - Street 1:425 CARRETERA 693
Mailing Address - Street 2:PMB 132
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0000
Mailing Address - Country:US
Mailing Address - Phone:787-756-7128
Mailing Address - Fax:787-765-1996
Practice Address - Street 1:PLAZA OLMEDO AVE LOMAS VERDES 1790
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-756-7128
Practice Address - Fax:787-765-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory