Laboratorio Clinico San Antonio

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

193 Issued in PR

Legal business name

LABORATORIO CLINICO SAN ANTONIO

Practice address

1488 Ave Emerito Estrada Rivera
San Sebastian, PR 00685-3023

Phone

(787) 896-1076

Fax

(787) 896-1076

NPI assigned

Oct 22, 2007

Organization subpart

No

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

Authorized official

Name

Maribel Gonzalez, M.T.NPI 1679554455

Title

Owner

Phone

(787) 896-1076

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Enrollment records 1

Locations

Practitioners 1

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

• Maribel Gonzalez, M.T.

  • Medical Technologist
  • San Sebastian, PR
  • NPI 1679554455
  NPD (past) Authorized official

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

{
    "created_epoch": "1193011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1710176177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2003",
            "city": "SAN SEBASTIAN",
            "state": "PR",
            "postal_code": "006858003",
            "telephone_number": "787-896-1076",
            "fax_number": "787-896-1076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1488 AVE EMERITO ESTRADA RIVERA",
            "city": "SAN SEBASTIAN",
            "state": "PR",
            "postal_code": "006853023",
            "telephone_number": "787-896-1076",
            "fax_number": "787-896-1076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LABORATORIO CLINICO SAN ANTONIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-22",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "MARIBEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-896-1076",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in San Sebastian, PR
• Providers in San Sebastian, PR by specialty
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; 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.