Provider Demographics
NPI:1063899342
Name:LABORATORIO CLINICO SUNRISE BAY INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO SUNRISE BAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-232-3231
Mailing Address - Street 1:PO BOX 367127
Mailing Address - Street 2:SAN JUAN STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-232-3231
Mailing Address - Fax:787-653-7451
Practice Address - Street 1:5900 AVE ISLA VERDE
Practice Address - Street 2:LOCAL #1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-232-3231
Practice Address - Fax:787-653-7451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1327291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory