Provider Demographics
NPI:1639659055
Name:LABORATORIO CLINICO SANTA JUANITA INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SANTA JUANITA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SERRANO TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-740-0870
Mailing Address - Street 1:AL20 CALLE 30
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4706
Mailing Address - Country:US
Mailing Address - Phone:787-740-0860
Mailing Address - Fax:787-740-0860
Practice Address - Street 1:AL20 CALLE 30
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4706
Practice Address - Country:US
Practice Address - Phone:787-740-0860
Practice Address - Fax:787-740-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory