Provider Demographics
NPI:1295844553
Name:LABORATORIO DEL SUENO INC
Entity Type:Organization
Organization Name:LABORATORIO DEL SUENO INC
Other - Org Name:SAN PABLO SLEEP DISORDERS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISPULO
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-786-8196
Mailing Address - Street 1:100 PASEO SAN PABLO
Mailing Address - Street 2:EDIFICIO ARTURO CADILLA SUITE 206
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7022
Mailing Address - Country:US
Mailing Address - Phone:787-786-8196
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:EDIFICIO ARTURO CADILLA SUITE 206
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7022
Practice Address - Country:US
Practice Address - Phone:787-786-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83968Medicare PIN