Lavoratorio Clinico San Antonio Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1265 Issued in PR

Legal business name

LAVORATORIO CLINICO SAN ANTONIO INC

Practice address

Carretera 411 KM 3.0
Barrio Jaguey
Aguada, PR 00602-2628

Phone

(787) 612-7527

Fax

(787) 826-7662

NPI assigned

Jul 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Sheila Barreto, MTNPI 1598883258

Title

Medical Technologist

Phone

(787) 612-7527

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lavoratorio Clinico San Antonio Inc

  • Clinical Medical Laboratory
  • Anasco, PR
  • NPI 1336108935

  O20060126000616

  Same enrollment

Tax ID family

Lab Clinico San Antonio2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lavoratorio Clinico San Antonio Inc

  • Clinical Medical Laboratory
  • Anasco, PR
  • NPI 1336108935
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sheila Barreto, MT

  • Medical Technologist
  • Aguada, PR
  • NPI 1598883258
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1124383773",
    "addresses": [
        {
            "country_code": "UM",
            "country_name": "United States Minor Outlying Islands",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "35 VILLAS DE SOTOMAYOR",
            "city": "AGUADA",
            "state": "PUERTO RICO",
            "postal_code": "00602",
            "telephone_number": "787-612-7527",
            "fax_number": "787-826-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CARRETERA 411 KM 3.0",
            "address_2": "BARRIO JAGUEY",
            "city": "AGUADA",
            "state": "PR",
            "postal_code": "006022628",
            "telephone_number": "787-612-7527",
            "fax_number": "787-826-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAVORATORIO CLINICO SAN ANTONIO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-10",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "BARRETO",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "MEDICAL TECHNOLOGIST",
        "authorized_official_telephone_number": "787-612-7527",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MT"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "40D2041381",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCIA PR",
            "identifier": "1265",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Edwin Lopez Rivera Sr., MD

• All providers in Aguada, PR
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.