Provider Demographics
NPI:1427010925
Name:SAN BLAS HEALTH CARE INC
Entity Type:Organization
Organization Name:SAN BLAS HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:SR
Authorized Official - Credentials:CPA OWNER
Authorized Official - Phone:787-825-4140
Mailing Address - Street 1:PO BOX 1933
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-738-0905
Mailing Address - Fax:787-738-0905
Practice Address - Street 1:CARR #1 KM 56 HM 7
Practice Address - Street 2:BO MONTELLANO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-0905
Practice Address - Fax:787-738-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1029291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30566Medicare ID - Type Unspecified