Provider Demographics
NPI:1497133037
Name:LS ID SPECIALTY PSC
Entity Type:Organization
Organization Name:LS ID SPECIALTY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-613-5742
Mailing Address - Street 1:AVENIDA JUAN MARTINEZ 14 CONDOMINIO MALAGA PARK
Mailing Address - Street 2:NUMBER 77
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-613-5742
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA JUAN MARTINEZ 14 CONDOMINIO MALAGA PARK
Practice Address - Street 2:NUMBER 77
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-613-5742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR338275OtherREGISTRY