Provider Demographics
NPI:1992112080
Name:LABORATORIO CLINICO DEL SURESTE,INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO DEL SURESTE,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YANIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-861-0100
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1340
Mailing Address - Country:US
Mailing Address - Phone:787-861-0100
Mailing Address - Fax:787-861-3156
Practice Address - Street 1:21 CALLE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2141
Practice Address - Country:US
Practice Address - Phone:787-861-0100
Practice Address - Fax:787-861-3156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO DEL SURESTE,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR597291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory