Provider Demographics
NPI:1639143886
Name:LABORATORIO CLINICO AMUNDARAY, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO AMUNDARAY, INC
Other - Org Name:LABORATORIO CLINICO AMUNDARAY, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-9760
Mailing Address - Street 1:2457 CALLE EUREKA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2219
Mailing Address - Country:US
Mailing Address - Phone:787-842-9760
Mailing Address - Fax:787-844-0898
Practice Address - Street 1:8155 CALLE CONCORDIA
Practice Address - Street 2:STE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1547
Practice Address - Country:US
Practice Address - Phone:787-842-9760
Practice Address - Fax:787-844-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31164Medicare PIN