Provider Demographics
NPI:1558615393
Name:EMPRESAS FIGUEROA-GOYTIA Y SONYA GOYTIA
Entity Type:Organization
Organization Name:EMPRESAS FIGUEROA-GOYTIA Y SONYA GOYTIA
Other - Org Name:LABORATORIO TRUJILLO ALTO
Other - Org Type:Other Name
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOYTIA
Authorized Official - Suffix:I
Authorized Official - Credentials:MS MT ASCP
Authorized Official - Phone:787-760-5179
Mailing Address - Street 1:BOX 1468 TRUJILLO ALTO
Mailing Address - Street 2:CALLE LA CRUZ 307 TRUJILLO ALTO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-760-5179
Mailing Address - Fax:787-760-4500
Practice Address - Street 1:CALLE LA CRUZ 307
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977-1468
Practice Address - Country:US
Practice Address - Phone:787-760-5179
Practice Address - Fax:787-760-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR556291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0658219OtherCLIA