Provider Demographics
NPI:1487212544
Name:PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
Entity Type:Organization
Organization Name:PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC
Other - Org Name:LABORATORY - IHS OF GUAYNABO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-523-5767
Mailing Address - Street 1:PO BOX 195615
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5615
Mailing Address - Country:US
Mailing Address - Phone:787-523-5767
Mailing Address - Fax:
Practice Address - Street 1:140 AVE LAS CUMBRES
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5523
Practice Address - Country:US
Practice Address - Phone:787-789-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory