Provider Demographics
NPI:1992796999
Name:LABORATORIO CLINICO SANTA ISABEL
Entity type:Organization
Organization Name:LABORATORIO CLINICO SANTA ISABEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-845-6315
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0179
Mailing Address - Country:US
Mailing Address - Phone:787-845-6315
Mailing Address - Fax:787-845-6315
Practice Address - Street 1:36 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2600
Practice Address - Country:US
Practice Address - Phone:787-845-6315
Practice Address - Fax:787-845-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0038290Medicare PIN