Provider Demographics
NPI:1457321143
Name:ANA LIVIA VAZQUEZ
Entity Type:Organization
Organization Name:ANA LIVIA VAZQUEZ
Other - Org Name:LABORATORIO MEDICO E INDUSTRIAL DEL SUR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LIVIA
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-837-3175
Mailing Address - Street 1:5 CALLE MARIO BRASCHI
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1623
Mailing Address - Country:US
Mailing Address - Phone:787-837-3175
Mailing Address - Fax:787-837-3175
Practice Address - Street 1:5 CALLE MARIO BRASCHI
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1623
Practice Address - Country:US
Practice Address - Phone:787-837-3175
Practice Address - Fax:787-837-3175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR632291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3-8291Medicare PIN