Provider Demographics
NPI:1689614455
Name:HEALTHCARE AMBULATORY SERVICES INC-LABORATORY CAGUAS
Entity type:Organization
Organization Name:HEALTHCARE AMBULATORY SERVICES INC-LABORATORY CAGUAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHADEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORDERO ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-414-3939
Mailing Address - Street 1:PMB 620 PO BOX 4952
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4952
Mailing Address - Country:US
Mailing Address - Phone:787-728-3030
Mailing Address - Fax:787-728-7050
Practice Address - Street 1:PLAZA DEL CARMEN MALL #24
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9999
Practice Address - Country:US
Practice Address - Phone:787-286-6060
Practice Address - Fax:787-286-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QE0002X, 261QR0200X
PR1056291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No291U00000XLaboratoriesClinical Medical Laboratory