Provider Demographics
NPI:1477560936
Name:LABORATORIO CLINICO LAS TUNAS, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO LAS TUNAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MT, ASCP
Authorized Official - Phone:787-873-0564
Mailing Address - Street 1:PO BOX 561679
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-4119
Mailing Address - Country:US
Mailing Address - Phone:787-873-0564
Mailing Address - Fax:787-873-0564
Practice Address - Street 1:CARR 121 KM 3.6
Practice Address - Street 2:URB LAS TUNAS
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-0564
Practice Address - Fax:787-873-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1104291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1104OtherPR LICENCE LABORATORY
40D1046215OtherCLIA