Provider Demographics
NPI:1346672854
Name:ST. CROIX DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:ST. CROIX DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAKERE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-718-7788
Mailing Address - Street 1:4040 ESTATE LA GRANDE PRINCESSE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5166
Mailing Address - Country:US
Mailing Address - Phone:340-718-7788
Mailing Address - Fax:340-718-9130
Practice Address - Street 1:4A & 4 AA ESTATE LA GRANDE PRINCESSE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-718-7788
Practice Address - Fax:340-718-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI621208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty