Provider Demographics
NPI:1265523583
Name:LABORATORIO SAGRADA FAMILIA CORP.
Entity type:Organization
Organization Name:LABORATORIO SAGRADA FAMILIA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENSY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-847-4700
Mailing Address - Street 1:URBANIZACION LAS ALONDRAS
Mailing Address - Street 2:CALLE 8 H5
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-847-4700
Mailing Address - Fax:787-847-4701
Practice Address - Street 1:SECTOR TIERRA SANTA
Practice Address - Street 2:CARR 149 KM 58.7
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-4700
Practice Address - Fax:787-847-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1060291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31330Medicare ID - Type Unspecified