Provider Demographics
NPI:1689605909
Name:LABORATORIO CLINICO HERMNS HIKASOBE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO HERMNS HIKASOBE
Other - Org Name:LABORATORIO CLINICO Y BACTERIOLOGICO AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-754-8818
Mailing Address - Street 1:RO65 CALLE CORRIENTES
Mailing Address - Street 2:RIACHUELO ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6141
Mailing Address - Country:US
Mailing Address - Phone:787-754-8818
Mailing Address - Fax:787-274-0186
Practice Address - Street 1:124 AVE ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2703
Practice Address - Country:US
Practice Address - Phone:787-754-8818
Practice Address - Fax:787-274-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR627291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31202Medicare PIN