Provider Demographics
NPI:1679540272
Name:LABORATORIO CLINICO EL SENORIAL, INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO EL SENORIAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DEL CARMEN
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-751-7028
Mailing Address - Street 1:180 AVE WINSTON CHURCHILL
Mailing Address - Street 2:URB CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-751-7028
Mailing Address - Fax:787-754-6568
Practice Address - Street 1:180 AVE WINSTON CHURCHILL
Practice Address - Street 2:URB CROWN HILLS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-751-7028
Practice Address - Fax:787-754-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR797291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038331Medicare ID - Type UnspecifiedPROVIDER #