Provider Demographics
NPI:1841377058
Name:TEJAV SANTURCE LAB SERVICES, INC.
Entity type:Organization
Organization Name:TEJAV SANTURCE LAB SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-763-3545
Mailing Address - Street 1:PO BOX 360632
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0632
Mailing Address - Country:US
Mailing Address - Phone:787-763-3545
Mailing Address - Fax:787-724-0545
Practice Address - Street 1:1427 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2658
Practice Address - Country:US
Practice Address - Phone:787-763-3545
Practice Address - Fax:787-724-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00910291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31573OtherSSS
PR9270028OtherHUMANA
PRLA-0267OtherPALIC
PR00910OtherHEALTH DEPARTMENT
PR400166OtherPREFERED HEALTH
PR51238OtherCRUZ AZUL
40D0922572OtherCLIA
PRB634OtherIMC
PR9270028OtherHUMANA