MEDICARE: LABORATORIO CLINICO HATO ARRIBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	291U00000X	Clinical Medical Laboratory	1017	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	20025	OTHER	PR	PREFERRED MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	800330	OTHER	PR	MMM HEALTHCARE
3	32053	OTHER	PR	PROSSAM
4	LA0515	OTHER	PR	PALIC NETWORD
5	052084	OTHER	PR	CRUZ AZUL
6	30902	OTHER	PR	TRIPLE S
7	6850032	OTHER	PR	HUMANA INSURANCE
8	20223	OTHER	PR	AMERICAN HEALTH
9	400566	OTHER	PR	PREFERRED HEALTH

General Provider Information

NPI Number	:	1821104654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO HATO ARRIBA

Provider Business Mailing Address
First Line	:	PO BOX 3175
Second Line	:	HATO ARRIBA STATION
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-7003
Country	:	US
Telephone Number	:	787-280-3085
Fax Number	:	787-280-3085

Provider Business Practice Location Address
First Line	:	CARRETERA 111 KM 14 5
Second Line	:	PLAZA HATO ARRIBA
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-7003
Country	:	US
Telephone Number	:	787-280-3085
Fax Number	:	787-280-3085

Authorized Official
Title or Position	:	GENERAL SUPERVISOR OWNER
Name	:	MRS. MAGDALENA CRUZ
Credential	:	MEDICAL TECHNOLOGY
Telephone Number	:	787-280-3085

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/12/2020

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