Provider Demographics
NPI:1316060445
Name:LABORATORIO CLINICO CRUZ
Entity type:Organization
Organization Name:LABORATORIO CLINICO CRUZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MT,ASCP
Authorized Official - Phone:787-857-2246
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0780
Mailing Address - Country:US
Mailing Address - Phone:787-857-2246
Mailing Address - Fax:787-857-1852
Practice Address - Street 1:8 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1776
Practice Address - Country:US
Practice Address - Phone:787-857-2246
Practice Address - Fax:787-857-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR232291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory