Provider Demographics
NPI:1346372844
Name:LABORATORIO CLINICO PROFESIONAL SAN MIGUEL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PROFESIONAL SAN MIGUEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-765-6069
Mailing Address - Street 1:PO BOX 21394
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1394
Mailing Address - Country:US
Mailing Address - Phone:787-765-6069
Mailing Address - Fax:787-765-6069
Practice Address - Street 1:112 CALLE ARZUAGA
Practice Address - Street 2:EDIFICIO MEDINA CENTER SUITE 905
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3321
Practice Address - Country:US
Practice Address - Phone:787-765-6069
Practice Address - Fax:787-765-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR318291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003-1473Medicare ID - Type Unspecified