Provider Demographics
NPI:1891766507
Name:MARITZA E GRAJALES SOTO
Entity Type:Organization
Organization Name:MARITZA E GRAJALES SOTO
Other - Org Name:LAB CLINICO LA MILAGROSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAJALES SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:BSMTASCP
Authorized Official - Phone:787-667-1902
Mailing Address - Street 1:PO BOX 3386
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3386
Mailing Address - Country:US
Mailing Address - Phone:787-769-8349
Mailing Address - Fax:787-257-8490
Practice Address - Street 1:AVE ROBERTO CLEMENTE CALLE 11 BLOQUE 33 # 17
Practice Address - Street 2:URB VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5436
Practice Address - Country:US
Practice Address - Phone:787-769-8349
Practice Address - Fax:787-257-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR266291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30387OtherMEDICARE OPTIMO
PR30387CLOtherSSS & SSS OPTIMO
PRITINOtherCIGNA & CIGNA EXCLUSIVE
PR40D0658056OtherCLIA
PRITINOtherFIRST PLUS MEDICARE ADVAN
PR50370OtherCRUZ AZUL
PR6300078OtherHUMANA
PRITINOtherMAPFRE & MAPFRE MEDICARE
PR20425OtherPREFFERED MEDICARE CHOICE
PR8392OtherFIRST MEDICAL- I.M.C.
PRITINOtherMCS REFORMA
PRITINOtherCOSVI
PR011266OtherGLOBAL HEALTH
PR400643OtherUTI- PREFFERED HEALTH
PRITINOtherMCS & MCS CLASSICARE
PRLA0066OtherPALIC- PANAMERICAN LIFE
PR1049OtherAMERICAN HEALTH
PR800210OtherMEDICARE Y MUCHO MAS-MMM
PRITINOtherOPTION HEALTHCARE
PRITINOtherCOSVI