Provider Demographics
NPI:1518235613
Name:LABORATORIO CLINICO MONTE SOL, LLC
Entity type:Organization
Organization Name:LABORATORIO CLINICO MONTE SOL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-293-3870
Mailing Address - Street 1:572 CALLE FERRARA
Mailing Address - Street 2:URB. VILLA CAPRI
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4047
Mailing Address - Country:US
Mailing Address - Phone:787-293-3870
Mailing Address - Fax:787-293-3870
Practice Address - Street 1:ROAD #3 KM. 49.7
Practice Address - Street 2:MONTE SOL SHOPPING CENTER SUITE 106
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-801-8181
Practice Address - Fax:787-801-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1245291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory