Provider Demographics
NPI:1265875058
Name:LISANDRA SUAREZ
Entity type:Organization
Organization Name:LISANDRA SUAREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-816-2600
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2194
Mailing Address - Country:US
Mailing Address - Phone:787-816-2600
Mailing Address - Fax:787-816-2600
Practice Address - Street 1:CARR. 10 KM 75.6 BO HATO VIEJO SOLAR #1
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00612
Practice Address - Country:UM
Practice Address - Phone:787-816-2600
Practice Address - Fax:787-816-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1274291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory