Provider Demographics
NPI:1760522437
Name:LABORATORIO CLINICO LAS ANTILLAS PSC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LAS ANTILLAS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALGUEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MT ASCP
Authorized Official - Phone:787-736-2636
Mailing Address - Street 1:PO BOX 373097
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-3097
Mailing Address - Country:US
Mailing Address - Phone:787-738-2232
Mailing Address - Fax:787-738-2288
Practice Address - Street 1:MUNOZ RIVERA 104 SUR
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-2232
Practice Address - Fax:787-738-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR590291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF816AMedicare UPIN
40D0658062Medicare ID - Type Unspecified