Provider Demographics
NPI:1124060843
Name:JOSE CARLOS FLORES SANTIAGO
Entity type:Organization
Organization Name:JOSE CARLOS FLORES SANTIAGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELTRAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-734-8126
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777
Mailing Address - Country:US
Mailing Address - Phone:787-734-8126
Mailing Address - Fax:787-734-1927
Practice Address - Street 1:CARR 189 KM 12.7
Practice Address - Street 2:CENTRO COMERCIAL VILLA ANA
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-8126
Practice Address - Fax:787-734-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR599291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031403Medicare PIN