Provider Demographics
NPI:1841431103
Name:LABORATORIO CLINICO BACTERIOLOGICO SABANA SECA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BACTERIOLOGICO SABANA SECA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGYS
Authorized Official - Prefix:MS
Authorized Official - First Name:CRUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-795-1080
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-0929
Mailing Address - Country:US
Mailing Address - Phone:787-795-1080
Mailing Address - Fax:787-795-1080
Practice Address - Street 1:AVE.RAMON RIOS ROMAN ESQ AVE 866
Practice Address - Street 2:PARCELA 59 B SABANA SECA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00952-9998
Practice Address - Country:US
Practice Address - Phone:787-795-1080
Practice Address - Fax:787-795-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0944291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031316Medicare PIN