Provider Demographics
NPI:1891880951
Name:LABORATORIO CLINICO ANEXO IRIZARRY GUASCH INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO ANEXO IRIZARRY GUASCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-899-7222
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-7222
Mailing Address - Fax:787-899-2900
Practice Address - Street 1:CARR PR 111 KM 18
Practice Address - Street 2:SAN SEBASTIAN SHOPPING CENTER
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-3609
Practice Address - Fax:787-280-3610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO ANEXO IRIZARRY GUASCH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR911291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRX15444Medicare UPIN
PR0031598Medicare PIN