Provider Demographics
NPI:1639390842
Name:LABORATORIO CLINICO SANTIAGO-IRIZARRY
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SANTIAGO-IRIZARRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO-IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MT ASCP MS
Authorized Official - Phone:787-380-1338
Mailing Address - Street 1:38 CALLE RODULFO GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-2333
Mailing Address - Country:US
Mailing Address - Phone:787-380-1338
Mailing Address - Fax:
Practice Address - Street 1:38 CALLE RODULFO GONZALEZ
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2333
Practice Address - Country:US
Practice Address - Phone:787-380-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR780291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory