Provider Demographics
NPI:1558349019
Name:CANOVANAS INTEGRATED LABORATORY SERVICES, INC
Entity Type:Organization
Organization Name:CANOVANAS INTEGRATED LABORATORY SERVICES, INC
Other - Org Name:LABORATORIO CLINICO CDT CANOVANAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CINTRN
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:787-256-1695
Mailing Address - Street 1:PO BOX 1935
Mailing Address - Street 2:
Mailing Address - City:CANVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3287
Mailing Address - Country:US
Mailing Address - Phone:787-256-1695
Mailing Address - Fax:787-256-1695
Practice Address - Street 1:200 CALLE CORCHADO
Practice Address - Street 2:SUITE 2
Practice Address - City:CANVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3287
Practice Address - Country:US
Practice Address - Phone:787-256-1695
Practice Address - Fax:787-256-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR961291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory