Provider Demographics
NPI:1629144399
Name:LABORATORIO CLINICO MONTEHIEDRA INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MONTEHIEDRA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-790-2377
Mailing Address - Street 1:9410 AVE LOS ROMEROS
Mailing Address - Street 2:STE. 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7007
Mailing Address - Country:US
Mailing Address - Phone:787-790-2377
Mailing Address - Fax:787-272-2377
Practice Address - Street 1:9410 AVE LOS ROMEROS
Practice Address - Street 2:STE. 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7007
Practice Address - Country:US
Practice Address - Phone:787-790-2377
Practice Address - Fax:787-272-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR914291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3-1276Medicare ID - Type Unspecified