Provider Demographics
NPI:1346248325
Name:LABORATORIO CLINICO IRIZARRY GUASCH
Entity Type:Organization
Organization Name:LABORATORIO CLINICO IRIZARRY GUASCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILZA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:IRIZARRY GUASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-899-7222
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0125
Mailing Address - Country:US
Mailing Address - Phone:787-899-7222
Mailing Address - Fax:787-899-2900
Practice Address - Street 1:65 INFANTERIA ESQUINA CONCORIA #13
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-7222
Practice Address - Fax:787-899-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
X15444Medicare UPIN
0030665Medicare ID - Type Unspecified