Provider Demographics
NPI:1245707561
Name:LABORATORIO CLINICO SANTIAGO INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO SANTIAGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAIMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-894-7482
Mailing Address - Street 1:83 CALLE DR CUETO
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2804
Mailing Address - Country:US
Mailing Address - Phone:787-894-7482
Mailing Address - Fax:787-894-5550
Practice Address - Street 1:83 CALLE DR CUETO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2804
Practice Address - Country:US
Practice Address - Phone:787-894-7482
Practice Address - Fax:787-894-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid