Healthcare Provider Details

I. General information

NPI: 1336108935
Provider Name (Legal Business Name): LAVORATORIO CLINICO SAN ANTONIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 402 KM 3.9 BARRIO CARACOL ANASCO
ANASCO PR
00610
US

IV. Provider business mailing address

35 VILLAS DE SOTOMAYOR
AGUADO PR
00602
US

V. Phone/Fax

Practice location:
  • Phone: 787-826-7662
  • Fax: 787-826-7662
Mailing address:
  • Phone: 787-252-8934
  • Fax: 787-252-8934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHEILA BARRETO V
Title or Position: TECNOLOGO MEDICO
Credential: BS MT
Phone: 787-826-7662