Provider Demographics
NPI:1871502864
Name:LABORATORIO CLINICO SANT ROSA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SANT ROSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-5065
Mailing Address - Street 1:2ND FLOOR SANTA ROSA MALL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-780-5065
Mailing Address - Fax:787-780-5066
Practice Address - Street 1:2ND FLOOR SANTA ROSA MALL
Practice Address - Street 2:SUITE 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-780-5065
Practice Address - Fax:787-780-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR297291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030970Medicare ID - Type Unspecified