Provider Demographics
NPI:1710056148
Name:LABORATORY SANDER INC.
Entity Type:Organization
Organization Name:LABORATORY SANDER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:CACHO
Authorized Official - Last Name:OLIVO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-798-1444
Mailing Address - Street 1:PO BOX 3143
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3143
Mailing Address - Country:US
Mailing Address - Phone:787-798-1444
Mailing Address - Fax:
Practice Address - Street 1:CARR 174 KM 4.5
Practice Address - Street 2:BO. JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR841291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31053Medicare ID - Type UnspecifiedLABORATORY