Provider Demographics
NPI:1710907621
Name:SANTA ANA LABORATORY SERVICES INCORPORATED
Entity Type:Organization
Organization Name:SANTA ANA LABORATORY SERVICES INCORPORATED
Other - Org Name:LABORATORIO CLINICO SANTA ANA
Other - Org Type:Other Name
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMARDO-DEFENDINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-272-2345
Mailing Address - Street 1:O-7 CALLE LAS AGUILAS
Mailing Address - Street 2:TIERRALTA II
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-272-2345
Mailing Address - Fax:787-708-2345
Practice Address - Street 1:CENTRO COMERCIAL PLAZA ALTA
Practice Address - Street 2:AVE. SANTA ANA 260
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-2345
Practice Address - Fax:787-708-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1091291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1091OtherDEPARTMENT OF HEALTH LIC.
PR=========OtherEIN
PR31468Medicare ID - Type Unspecified