Provider Demographics
NPI:1629348560
Name:LABORATORIO CLINICO CDT DR. JOSE S BELAVAL
Entity Type:Organization
Organization Name:LABORATORIO CLINICO CDT DR. JOSE S BELAVAL
Other - Org Name:LABORATORIO CLINICO CDT DR JOSE S BELAVAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:CLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-480-3838
Mailing Address - Street 1:CALLE PINEIRO ESQ CALLE VALLEJO RIO PIEDRAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-0000
Mailing Address - Country:US
Mailing Address - Phone:787-480-3841
Mailing Address - Fax:787-977-0544
Practice Address - Street 1:AVENIDA BORINQUEN ESQUINA CALLE NIN BO. OBRERO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-0000
Practice Address - Country:US
Practice Address - Phone:787-480-5040
Practice Address - Fax:787-977-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR37747300Medicaid
PR=========Medicaid