Provider Demographics
NPI:1568452522
Name:SAHUDY AMADOR LOPEZ/DBA LABORATORIO CLINICO MOLDONADO AVILES
Entity Type:Organization
Organization Name:SAHUDY AMADOR LOPEZ/DBA LABORATORIO CLINICO MOLDONADO AVILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAHUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT, ASCP
Authorized Official - Phone:787-898-2106
Mailing Address - Street 1:47 URB VISTA VERDE
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-3302
Mailing Address - Country:US
Mailing Address - Phone:787-898-2106
Mailing Address - Fax:787-898-2106
Practice Address - Street 1:#131 MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-2106
Practice Address - Fax:787-898-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR513291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31235Medicare ID - Type UnspecifiedPROVIDER NUMBER