MEDICARE: LABORATORIO CLINICO LOIZA VALLEY 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	694	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400111	OTHER	PR	PREFERRED HEALTH
2	00694	OTHER	PR	GLOBAL HEALTH PLAN
3	051290	OTHER	PR	LA CRUZ AZUL DE PR
4	20401	OTHER	PR	AMERICAN HEALTH INC.
5	30568	OTHER	PR	BLUE CROSS BLUE SHIELD
6	1424-3	OTHER	PR	ASOCIACION DE MAESTROS
7	30568	OTHER	PR	TRIPLE SSS
8	6004296	OTHER	PR	ACAA

General Provider Information

NPI Number	:	1598769861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO LOIZA VALLEY INC.

Provider Business Mailing Address
First Line	:	PO BOX 937
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-0937
Country	:	US
Telephone Number	:	787-876-0430
Fax Number	:	787-256-1836

Provider Business Practice Location Address
First Line	:	LOIZA VALLEY MALL
Second Line	:	BAUHINIA Z-977
City	:	CANOVANAS
State	:	PR
Zip	:	00729
Country	:	US
Telephone Number	:	787-876-0430
Fax Number	:	787-256-1836

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SANDRA MILAGROS SALICRUP
Credential	:	MT
Telephone Number	:	787-876-0430

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/22/2020

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