Provider Demographics
NPI:1265639819
Name:LABORATORIO CLINICO SOFIA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SOFIA
Other - Org Name:LABORATORIO CLINICO SOFIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-5881
Mailing Address - Street 1:42 CALLE DR SANTIAGO VEVE
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4052
Mailing Address - Country:US
Mailing Address - Phone:787-892-5881
Mailing Address - Fax:787-892-5881
Practice Address - Street 1:DR VEVE #42
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-5881
Practice Address - Fax:787-892-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR382291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory