Provider Demographics
NPI:1558329615
Name:ISMAEL PEREZ PTR
Entity Type:Organization
Organization Name:ISMAEL PEREZ PTR
Other - Org Name:LABORATORIO SAN SEBASTIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDUJAR-RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-896-3161
Mailing Address - Street 1:424 AVE EMERITO ESTRADA STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-3113
Mailing Address - Country:US
Mailing Address - Phone:787-896-3161
Mailing Address - Fax:787-896-3161
Practice Address - Street 1:424 AVE EMERITO ESTRADA STE 1
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3113
Practice Address - Country:US
Practice Address - Phone:787-896-3161
Practice Address - Fax:787-896-3161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR728291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRY11960Medicare UPIN
PR0031430Medicare ID - Type Unspecified