Provider Demographics
NPI:1699944090
Name:CRESPO, MARIA LOUISA (MT(ASCP))
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LOUISA
Last Name:CRESPO
Suffix:
Gender:F
Credentials:MT(ASCP)
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:CLINICO
Other - Last Name:BACTERIOLOGICO SAN ANTONIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
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:787-890-6161
Mailing Address - Fax:787-890-6161
Practice Address - Street 1:1065 AVE GENERAL RAMEY
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN ANTONIO
Practice Address - State:PR
Practice Address - Zip Code:00690-1117
Practice Address - Country:US
Practice Address - Phone:787-890-6161
Practice Address - Fax:787-890-6161
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR761291U00000X
PR2870246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR051502OtherBLUE CROSS
PR800386OtherMMM
PRLA 0179OtherPAN AMERICAN LIFE
PR5599OtherAMERICAN HEALTH MEDICARE
PR6030045OtherHUMANA HEALTH INS
PR0152OtherINTERNATIONAL MEDICAL CARD
PR30731OtherSSS
PRA0170OtherFIRST PLUS
PR5599OtherAMERICAN HEALTH MEDICARE