Provider Demographics
NPI:1053941013
Name:LIZA M. MONTES SANTIAGO DBA INNOVA LAB
Entity type:Organization
Organization Name:LIZA M. MONTES SANTIAGO DBA INNOVA LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-856-4005
Mailing Address - Street 1:52 CALLE MATTEI LLUBERAS
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3666
Mailing Address - Country:US
Mailing Address - Phone:787-856-4005
Mailing Address - Fax:787-856-4005
Practice Address - Street 1:52 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3666
Practice Address - Country:US
Practice Address - Phone:787-856-4005
Practice Address - Fax:787-856-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory