Provider Demographics
NPI:1053765354
Name:LABORATORIO CLINICO SAN JUAN INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO SAN JUAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARRIETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-756-7128
Mailing Address - Street 1:JL-32 AVENIDA CARLOS JAVIER ANDALUZ
Mailing Address - Street 2:ROYAL PALM
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-0000
Mailing Address - Country:US
Mailing Address - Phone:787-756-7128
Mailing Address - Fax:
Practice Address - Street 1:425 CARR 693 STE 1
Practice Address - Street 2:PMB 132
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4817
Practice Address - Country:US
Practice Address - Phone:787-554-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR812291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory