Provider Demographics
NPI:1336108935
Name:LAVORATORIO CLINICO SAN ANTONIO INC
Entity Type:Organization
Organization Name:LAVORATORIO CLINICO SAN ANTONIO INC
Other - Org Name:NOMBRE DEL DUENO DEL LABORTONIO
Other - Org Type:Other Name
Authorized Official - Title/Position:TECNOLOGO MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:V
Authorized Official - Credentials:BS MT
Authorized Official - Phone:787-826-7662
Mailing Address - Street 1:35 VILLAS DE SOTOMAYOR
Mailing Address - Street 2:
Mailing Address - City:AGUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-252-8934
Mailing Address - Fax:787-252-8934
Practice Address - Street 1:CARRETERA 402 KM 3.9
Practice Address - Street 2:BARRIO CARACOL ANASCO
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-7662
Practice Address - Fax:787-826-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
4001045313OtherCMS
PR1096OtherDEPARTEMENTO DE SALUD PR
4001045313OtherCMS