Provider Demographics
NPI:1740396050
Name:SAN JUAN MEDICAL LABORATORY
Entity Type:Organization
Organization Name:SAN JUAN MEDICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:JAIME
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:787-722-5636
Mailing Address - Street 1:M3 CALLE CLAVEL
Mailing Address - Street 2:PARQUES DE SANTA MARIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6738
Mailing Address - Country:US
Mailing Address - Phone:787-722-5636
Mailing Address - Fax:
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:EDIFICIO SAN JUAN HEALTH CENTRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-722-5636
Practice Address - Fax:787-722-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR710291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory