Provider Demographics
NPI:1457788226
Name:LABORATORIO PERIFEROVASCULAR CSA, INC.
Entity Type:Organization
Organization Name:LABORATORIO PERIFEROVASCULAR CSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-879-4632
Mailing Address - Street 1:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0575
Mailing Address - Country:US
Mailing Address - Phone:787-879-4632
Mailing Address - Fax:787-881-5762
Practice Address - Street 1:622 AVE SAN LUIS CARR. 129
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0575
Practice Address - Country:US
Practice Address - Phone:787-879-4632
Practice Address - Fax:787-881-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R10011X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6407OtherINTERVENTIONAL CARDIOLOGY
PR207R10011XOtherINTERNAL MEDICINE
PRAS1610953OtherDEA
PR098752Medicare PIN
PR207R10011XOtherINTERNAL MEDICINE