Provider Demographics
NPI:1326035957
Name:LABORATORIO CLINICO SAN MARTIN
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SAN MARTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FANCISCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:TECNOLOGO MEDICO
Authorized Official - Phone:787-897-2479
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0787
Mailing Address - Country:US
Mailing Address - Phone:787-897-2479
Mailing Address - Fax:787-897-2479
Practice Address - Street 1:75 DR PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0787
Practice Address - Country:US
Practice Address - Phone:787-897-2479
Practice Address - Fax:787-897-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR454291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30896Medicare ID - Type Unspecified