Provider Demographics
NPI:1285788638
Name:LABORATORIO CLINICO SANTA RITA
Entity type:Organization
Organization Name:LABORATORIO CLINICO SANTA RITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAJIGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-269-1140
Mailing Address - Street 1:PO BOX 9398
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9398
Mailing Address - Country:US
Mailing Address - Phone:787-269-1140
Mailing Address - Fax:787-269-1160
Practice Address - Street 1:EDIFICIO MEDICO HNAS. DAVILA, SUITE 104
Practice Address - Street 2:CALLE B, ESQ. J, HNAS. DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-269-1140
Practice Address - Fax:787-269-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR182291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030863Medicare PIN