Provider Demographics
NPI:1942420294
Name:HERNANDEZ BUITRAGO & SONS INC
Entity Type:Organization
Organization Name:HERNANDEZ BUITRAGO & SONS INC
Other - Org Name:LABORATORIO CLINICO PLAZA GUAYAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BUITRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-864-0561
Mailing Address - Street 1:PO BOX 2308
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2308
Mailing Address - Country:US
Mailing Address - Phone:787-864-0561
Mailing Address - Fax:
Practice Address - Street 1:COMMERCE PLAZA
Practice Address - Street 2:SUITE 203
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR898291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31142Medicare ID - Type Unspecified