Provider Demographics
NPI:1841602653
Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Other - Org Name:LABORATORIO CLINICO IRIZARRY GUASCH INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-7222
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-0593
Mailing Address - Country:US
Mailing Address - Phone:787-851-8100
Mailing Address - Fax:787-851-8101
Practice Address - Street 1:CARR PR 308 KM 0.3
Practice Address - Street 2:CONDOMINIO SAN JOSE SUITES 101 Y 102
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-8100
Practice Address - Fax:787-851-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1303291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31596Medicare PIN