Provider Demographics
NPI:1285332353
Name:SPECIALTY LABS OF PUERTO RICO
Entity type:Organization
Organization Name:SPECIALTY LABS OF PUERTO RICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-274-0551
Mailing Address - Street 1:PO BOX 741621
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-1621
Mailing Address - Country:US
Mailing Address - Phone:787-274-0551
Mailing Address - Fax:787-332-1736
Practice Address - Street 1:142 CALLE MAYAGUEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5163
Practice Address - Country:US
Practice Address - Phone:787-274-0551
Practice Address - Fax:866-537-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory