Provider Demographics
NPI:1639169006
Name:LABORATORIO CLINICO PLAZA REAL INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA REAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-1444
Mailing Address - Street 1:1 AVE ARBOLOTE
Mailing Address - Street 2:SUITE 302 PLAZA REAL MALL
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-2806
Mailing Address - Country:US
Mailing Address - Phone:787-720-1444
Mailing Address - Fax:787-963-0446
Practice Address - Street 1:1 AVE ARBOLOTE
Practice Address - Street 2:SUITE 302 PLAZA REAL MALL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-2806
Practice Address - Country:US
Practice Address - Phone:787-720-1444
Practice Address - Fax:787-963-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR702291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6570083OtherHUMANA
PRL-400141OtherPREFERRED HEALTH PLAN
PR800220OtherMMM PROVIDER NUMBER
PR051307OtherCRUZ AZUL DE PR
PR20213OtherAMERICAN HEALTH
PR30716OtherSSS
PR1271OtherINTERNATIONAL MEDICAL CAR
PR20278OtherPREFERRED MEDICAL CHOICE
PR=========OtherCOSVI
PRL-400141OtherPREFERRED HEALTH PLAN
PR1271OtherINTERNATIONAL MEDICAL CAR
PR800220OtherMMM PROVIDER NUMBER
PR=========OtherCIGNA PROVIDER NUMBER
PR6570083OtherHUMANA
PR=========OtherFIRST PLUS
PR=========OtherCIGNA PROVIDER NUMBER