Provider Demographics
NPI:1821104654
Name:LABORATORIO CLINICO HATO ARRIBA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO HATO ARRIBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGY
Authorized Official - Phone:787-280-3085
Mailing Address - Street 1:PO BOX 3175
Mailing Address - Street 2:HATO ARRIBA STATION
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7003
Mailing Address - Country:US
Mailing Address - Phone:787-280-3085
Mailing Address - Fax:787-280-3085
Practice Address - Street 1:CARRETERA 111 KM 14 5
Practice Address - Street 2:PLAZA HATO ARRIBA
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-7003
Practice Address - Country:US
Practice Address - Phone:787-280-3085
Practice Address - Fax:787-280-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1017291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR800330OtherMMM HEALTHCARE
PR20025OtherPREFERRED MEDICARE CHOICE
PR32053OtherPROSSAM
PRLA0515OtherPALIC NETWORD
PR052084OtherCRUZ AZUL
PR30902OtherTRIPLE S
PR6850032OtherHUMANA INSURANCE
PR20223OtherAMERICAN HEALTH
PR400566OtherPREFERRED HEALTH
PR=========OtherBELLA VISTA
PR=========OtherCOSVI
PR=========OtherMAPFRE
PR6850032OtherHUMANA INSURANCE
PR800330OtherMMM HEALTHCARE
PR=========OtherINTERNATIONAL MEDICAL CAR
PR30902Medicare ID - Type Unspecified