Provider Demographics
NPI:1306043948
Name:LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO ORIENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-850-6045
Mailing Address - Street 1:PO BOX 10034
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-1120
Mailing Address - Country:US
Mailing Address - Phone:787-850-6045
Mailing Address - Fax:787-850-6045
Practice Address - Street 1:CALLE 13 BC1 VILLA UNIVERSITARIA
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-6045
Practice Address - Fax:787-850-6045
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
PR779291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory