Provider Demographics
NPI:1467991182
Name:LABORATORIO CLINICO PORTAL DEL SOL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PORTAL DEL SOL
Other - Org Name:LABORATORIO CLINICO PORTAL DEL SOL P.S.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOLANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1787-872-3480
Mailing Address - Street 1:7 AVE JUAN HERNANDEZ ORTIZ
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3602
Mailing Address - Country:US
Mailing Address - Phone:787-872-3480
Mailing Address - Fax:787-872-3480
Practice Address - Street 1:7 AVE JUAN HERNANDEZ ORTIZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3602
Practice Address - Country:US
Practice Address - Phone:787-872-3480
Practice Address - Fax:787-872-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR630291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory