Provider Demographics
NPI:1588157754
Name:LABORATORIO CLINICO BACTERIOLOGICO SAN ANTONIO II INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BACTERIOLOGICO SAN ANTONIO II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOUISA
Authorized Official - Last Name:CRESPO
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP)
Authorized Official - Phone:787-890-6161
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-0791
Mailing Address - Country:US
Mailing Address - Phone:787-431-1188
Mailing Address - Fax:
Practice Address - Street 1:2071 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:SUITE 1
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-890-5454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory