MEDICARE: LAS LOMAS LABORATORY INC.

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	374	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	800313	OTHER	PR	MEDICARE Y MUCHO MAS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400309	OTHER	PR	UTI PREFERRED HEALTH PLAN
2	31498	OTHER	PR	TRIPLE S
3	6578	OTHER	PR	INTERNATIONAL MEDICAL CAR
4	051822	OTHER	PR	LA CRUZ AZUL PR
6	9210002	OTHER	PR	HUMANA INSURANCE
7	LA0304	OTHER	PR	PANAMERICAN LIFE INS
8	LB374	OTHER	PR	UIA

General Provider Information

NPI Number	:	1043283971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS LOMAS LABORATORY INC.

Provider Business Mailing Address
First Line	:	PO BOX 367027
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-7027
Country	:	US
Telephone Number	:	787-792-1824
Fax Number	:	787-783-6350

Provider Business Practice Location Address
First Line	:	AVE. JESUS T PINERO ESQ. AVE. SAN PATRICIO LOCAL 32
Second Line	:	LAS LOMAS PROFESIONAL CENTER
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1489
Country	:	US
Telephone Number	:	787-792-1824
Fax Number	:	787-783-6350

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	MR. WILSON LOPEZ-LOPEZ
Credential	:
Telephone Number	:	787-792-1824

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	11/20/2015

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