Provider Demographics
NPI:1477978450
Name:ESTLYAN LAB, INC
Entity Type:Organization
Organization Name:ESTLYAN LAB, INC
Other - Org Name:ESTLYAN CLINICAL LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-271-6602
Mailing Address - Street 1:F2 CALLE C
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-3209
Mailing Address - Country:US
Mailing Address - Phone:787-685-8486
Mailing Address - Fax:
Practice Address - Street 1:CALLE GUILLERMO RIEFKOHL NUM. 8
Practice Address - Street 2:
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-271-6602
Practice Address - Fax:787-271-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1311291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory