Provider Demographics
NPI:1730490459
Name:LABORATORIO CLINICO EL CRUCE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EL CRUCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZYLKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FELICIANO-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-7777
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1593
Mailing Address - Country:US
Mailing Address - Phone:787-280-7777
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 435 KM 0.1
Practice Address - Street 2:BARRIO CALABAZAS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1243291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory