Healthcare Provider Details

I. General information

NPI: 1285703132
Provider Name (Legal Business Name): LABORATORIO CLINICO IRIZARRY GUASCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE PROVIDENCIA BARRERO
SAN SEBASTIAN PR
00685-2146
US

IV. Provider business mailing address

PO BOX 125
LAJAS PR
00667
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-6520
  • Fax: 787-896-6520
Mailing address:
  • Phone: 787-899-7222
  • Fax: 787-899-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number644
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOSE RAFAEL SANCHEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-899-7222