Provider Demographics
NPI:1104911981
Name:LABORATORIO CLINICO SHAREM
Entity type:Organization
Organization Name:LABORATORIO CLINICO SHAREM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRACION
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-312-7059
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0695
Mailing Address - Country:US
Mailing Address - Phone:787-703-1275
Mailing Address - Fax:787-745-1370
Practice Address - Street 1:REG 295 DEL RIO SHOPPING
Practice Address - Street 2:VALLE TOLIMA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2337
Practice Address - Country:US
Practice Address - Phone:787-703-1275
Practice Address - Fax:787-745-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR997291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30082Medicare PIN