Provider Demographics
NPI:1508475757
Name:HIGH PROFILE LABORATORY SAN JUAN LLC
Entity Type:Organization
Organization Name:HIGH PROFILE LABORATORY SAN JUAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRETJER RIPOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-230-7556
Mailing Address - Street 1:PMB 355 AVE ESMERALDA 405
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-230-7556
Mailing Address - Fax:787-705-0978
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SAN JUAN HEALTH CENTER BLDG SUITE 402
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-230-7556
Practice Address - Fax:787-705-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory