Provider Demographics
NPI:1770572075
Name:LABORATORIO CLINICO SABANA DEL PALMAR
Entity type:Organization
Organization Name:LABORATORIO CLINICO SABANA DEL PALMAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-875-8335
Mailing Address - Street 1:PO BOX 1134
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-1134
Mailing Address - Country:US
Mailing Address - Phone:787-875-8335
Mailing Address - Fax:787-875-7707
Practice Address - Street 1:81 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-1134
Practice Address - Country:US
Practice Address - Phone:787-875-8335
Practice Address - Fax:787-875-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR484291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30270Medicare ID - Type Unspecified