Provider Demographics
NPI:1265827109
Name:LABORATORIO MEDICO E INDUSTRIAL DEL SUR, CORP.
Entity Type:Organization
Organization Name:LABORATORIO MEDICO E INDUSTRIAL DEL SUR, CORP.
Other - Org Name:LABORATORIO CLINICO MEDICO DEL SUR, CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAN ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-831-3175
Mailing Address - Street 1:64 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1607
Mailing Address - Country:US
Mailing Address - Phone:787-837-3175
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1607
Practice Address - Country:US
Practice Address - Phone:787-837-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR632291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory