Provider Demographics
NPI:1770514150
Name:LABORATORIO CLINICO HNOS MIKASOBE,LLC
Entity type:Organization
Organization Name:LABORATORIO CLINICO HNOS MIKASOBE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-876-3697
Mailing Address - Street 1:PO BOX 10,0000
Mailing Address - Street 2:PMB 157
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3243
Mailing Address - Country:US
Mailing Address - Phone:787-876-3697
Mailing Address - Fax:787-256-5538
Practice Address - Street 1:68 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3243
Practice Address - Country:US
Practice Address - Phone:787-876-3697
Practice Address - Fax:787-256-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR342291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31308Medicare PIN