Provider Demographics
NPI:1518133628
Name:LABORATORIO CLINICO LOS ANGELES MEDICAL CLINIC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LOS ANGELES MEDICAL CLINIC
Other - Org Name:LOS ANGELES MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-6626
Mailing Address - Street 1:1400 CALLE SAN RAFAEL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2693
Mailing Address - Country:US
Mailing Address - Phone:787-721-6626
Mailing Address - Fax:787-725-1287
Practice Address - Street 1:1400 CALLE SAN RAFAEL
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-2693
Practice Address - Country:US
Practice Address - Phone:787-721-6626
Practice Address - Fax:787-725-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1158291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory