Provider Demographics
NPI:1992836068
Name:FREDDY MAS VARGAS
Entity Type:Organization
Organization Name:FREDDY MAS VARGAS
Other - Org Name:LABORATORIO CLINICO JERUSALEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-868-4453
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0745
Mailing Address - Country:US
Mailing Address - Phone:787-868-4453
Mailing Address - Fax:787-868-0780
Practice Address - Street 1:CARR. 417 KM 3.0 BO. MALPASO
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-4453
Practice Address - Fax:787-868-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR878291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031010Medicare PIN