Provider Demographics
NPI:1598741753
Name:LABORATORIO CLINICO TIERRA SANTA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO TIERRA SANTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA ECHEUARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:787-847-6948
Mailing Address - Street 1:507 BO TIERRA SANTA # 149
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2377
Mailing Address - Country:US
Mailing Address - Phone:787-847-6948
Mailing Address - Fax:787-847-6948
Practice Address - Street 1:507 CARR 149
Practice Address - Street 2:BO TIERRA SANTA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-6948
Practice Address - Fax:787-847-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1021291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30920Medicare PIN