Provider Demographics
NPI:1780759696
Name:LABORATORIO SAN RAFAEL 2000 INC
Entity type:Organization
Organization Name:LABORATORIO SAN RAFAEL 2000 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-872-4330
Mailing Address - Street 1:PO BOX 1365
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1365
Mailing Address - Country:US
Mailing Address - Phone:787-872-4330
Mailing Address - Fax:
Practice Address - Street 1:113 CALLE EMILIO GONZALEZ
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2656
Practice Address - Country:US
Practice Address - Phone:787-872-4330
Practice Address - Fax:787-872-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00683291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHE218AMedicare PIN