Provider Demographics
NPI:1568805489
Name:LABORATORIO CLINICIO PROSALUD ISABELA PSC
Entity Type:Organization
Organization Name:LABORATORIO CLINICIO PROSALUD ISABELA PSC
Other - Org Name:LABORATORIO CLINICO PROSALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:TAVAREZ
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-646-7428
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0956
Mailing Address - Country:US
Mailing Address - Phone:787-830-3138
Mailing Address - Fax:787-830-3138
Practice Address - Street 1:BARRIO COTO
Practice Address - Street 2:CARR. 474 KM 2.2
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-3138
Practice Address - Fax:787-830-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1153291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory