Provider Demographics
NPI:1326166760
Name:SOFIA I GONZALEZ VELEZ
Entity Type:Organization
Organization Name:SOFIA I GONZALEZ VELEZ
Other - Org Name:LABORATORIO CLINICO SOFIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-895-2475
Mailing Address - Street 1:206 CALLE SAN JUSTO
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1740
Mailing Address - Country:US
Mailing Address - Phone:787-895-2475
Mailing Address - Fax:787-895-4964
Practice Address - Street 1:206 CALLE SAN JUSTO
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1740
Practice Address - Country:US
Practice Address - Phone:787-895-2475
Practice Address - Fax:787-895-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2861291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30663Medicare PIN