Provider Demographics
NPI:1144336488
Name:LABORATORIO CLINICO SANTANA
Entity type:Organization
Organization Name:LABORATORIO CLINICO SANTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-821-2610
Mailing Address - Street 1:45 CALLE 25 DE JULIO
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-2713
Mailing Address - Country:US
Mailing Address - Phone:787-821-2610
Mailing Address - Fax:787-821-0268
Practice Address - Street 1:45 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2713
Practice Address - Country:US
Practice Address - Phone:787-821-2610
Practice Address - Fax:787-821-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0651291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38306Medicare ID - Type Unspecified