Provider Demographics
NPI:1487653481
Name:KSAS INTERAMERICAN LAB. INC.
Entity Type:Organization
Organization Name:KSAS INTERAMERICAN LAB. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-2282
Mailing Address - Street 1:LOCAL 1 CALLE SANTA ROSA
Mailing Address - Street 2:URB SAN JUAN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-756-7128
Mailing Address - Fax:787-765-1996
Practice Address - Street 1:1 CALLE SANTA ROSA
Practice Address - Street 2:URB SAN JUAN GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5403
Practice Address - Country:US
Practice Address - Phone:787-756-7128
Practice Address - Fax:787-765-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR889291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31254Medicare PIN