Provider Demographics
NPI:1740328400
Name:LABORATORIO CLINICO SANTA CRUZ CORP.
Entity type:Organization
Organization Name:LABORATORIO CLINICO SANTA CRUZ CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR GENERAL
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC 5496
Authorized Official - Phone:787-755-8751
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:PMB 208
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2510
Mailing Address - Country:US
Mailing Address - Phone:787-755-8751
Mailing Address - Fax:
Practice Address - Street 1:181 ST. KM 9.2
Practice Address - Street 2:QUEBRADA GRANDE
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977
Practice Address - Country:US
Practice Address - Phone:787-755-8751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1076291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031424Medicare PIN