Provider Demographics
NPI:1801192901
Name:LAABES MEDICAL PSC
Entity type:Organization
Organization Name:LAABES MEDICAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAABES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-585-7580
Mailing Address - Street 1:510 CALLE FRANCISCO CAMACHO APT 1104
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2442
Mailing Address - Country:US
Mailing Address - Phone:787-585-7580
Mailing Address - Fax:787-868-8811
Practice Address - Street 1:CARR 417 KM 2.7
Practice Address - Street 2:BO MALPASO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9857
Practice Address - Country:US
Practice Address - Phone:787-868-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X, 261QP2300X
PR17717261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17717OtherPUERTO RICO BOARD OF LICENSING AND MEDICAL DISCIPLINES
FA597AMedicare PIN