Provider Demographics
NPI:1942900444
Name:LABORATORIO CLINICO SALUD Y VIDA LLC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO SALUD Y VIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:ESTADES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MT
Authorized Official - Phone:787-915-5052
Mailing Address - Street 1:SAN DEMETRIO CALLE CASABE 152
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-915-5052
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 43.3 BO. ALGARROBOS LOCAL 3
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-236-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4836050OtherDRIVER LICENSE