Provider Demographics
NPI:1801911243
Name:LABORATORIO DR. AGUSTIN STAHL
Entity type:Organization
Organization Name:LABORATORIO DR. AGUSTIN STAHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIN ERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEREO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-787-1691
Mailing Address - Street 1:CARR 174 BLOQUE 21 # 20, SANTA ROSA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6512
Mailing Address - Country:US
Mailing Address - Phone:787-787-1691
Mailing Address - Fax:787-740-1770
Practice Address - Street 1:CARR. 174 BLOQUE 21 # 20,
Practice Address - Street 2:SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6512
Practice Address - Country:US
Practice Address - Phone:787-787-1691
Practice Address - Fax:787-740-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR473291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38303Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER