Healthcare Provider Details

I. General information

NPI: 1487653481
Provider Name (Legal Business Name): KSAS INTERAMERICAN LAB. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE SANTA ROSA URB SAN JUAN GARDENS
SAN JUAN PR
00926-5403
US

IV. Provider business mailing address

LOCAL 1 CALLE SANTA ROSA URB SAN JUAN GARDENS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-7128
  • Fax: 787-765-1996
Mailing address:
  • Phone: 787-756-7128
  • Fax: 787-765-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number889
License Number StatePR

VIII. Authorized Official

Name: MS. CARMEN LYDIA ARRIETA
Title or Position: PRESIDENTA
Credential:
Phone: 787-796-2282