Provider Demographics
NPI:1376524629
Name:LABORATORIO CLINICA SAN FRANCISCO
Entity Type:Organization
Organization Name:LABORATORIO CLINICA SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURACION
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:SUPERVISOR
Authorized Official - Phone:787-252-8330
Mailing Address - Street 1:APDO 592
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-252-8330
Mailing Address - Fax:
Practice Address - Street 1:CALLE COLON # 106
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3166
Practice Address - Country:US
Practice Address - Phone:787-252-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR981291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030643Medicare PIN