Provider Demographics
NPI:1932186855
Name:NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO
Entity type:Organization
Organization Name:NILSA IVETTE SANCHEZ SHUMATE/LABORATORIO CLINICO MODELO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NILSA
Authorized Official - Middle Name:I
Authorized Official - Last Name:SANCHEZ SHUMATE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:787-788-1428
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00963-0598
Mailing Address - Country:US
Mailing Address - Phone:787-788-1428
Mailing Address - Fax:787-788-2409
Practice Address - Street 1:170 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-788-1428
Practice Address - Fax:787-788-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR523291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1000OtherAMERICAN HEALTH MEDICARE
PR20141OtherPREFERRED MEDICARE CHOICE
PR3-0315OtherSSS, OPTIMO, SELECTO
PR400646OtherPREFERRED HEALTH
PR3-0315Medicaid
PR011-523OtherGLOBAL HEALTH PLAN
PRLA-0244OtherPALIC
PR0794OtherINTERNATIONAL MEDICAL CAR
PR1349OtherAPS
PR20200OtherAMERICAN HEALTH
PR800047OtherMMM
PR962-0064OtherHUMANA
PR=========OtherMCS CLASSICARE
PR=========OtherFIRST PLUS
PR3-0315Medicaid
PR962-0064OtherHUMANA
PR=========OtherCIGNA
PRLA-0244OtherPALIC
PR0794OtherINTERNATIONAL MEDICAL CAR
PR30860Medicare PIN