Provider Demographics
NPI:1740517911
Name:LABORATORIO CLINICO BACTERIOLOGICO SANTIAGO INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BACTERIOLOGICO SANTIAGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAIMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-894-7482
Mailing Address - Street 1:CALLE DR. CUETO
Mailing Address - Street 2:# 83
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641
Mailing Address - Country:US
Mailing Address - Phone:787-894-7482
Mailing Address - Fax:
Practice Address - Street 1:CALLE DR. CUETO
Practice Address - Street 2:# 83
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-894-7482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory