Provider Demographics
NPI:1700251766
Name:LABORATORIOS DEL SUENO DE PUERTO RICO
Entity Type:Organization
Organization Name:LABORATORIOS DEL SUENO DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-986-7010
Mailing Address - Street 1:55 CALLE DE DIEGO E STE 405
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5082
Mailing Address - Country:US
Mailing Address - Phone:787-891-4446
Mailing Address - Fax:787-891-4425
Practice Address - Street 1:CARR 2 KM 122.5
Practice Address - Street 2:BO CORRALES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4996
Practice Address - Country:US
Practice Address - Phone:787-986-7010
Practice Address - Fax:787-805-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR516492291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory