1093941064 NPI number — GLADYS MORENO RODRIGUEZ

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093941064 NPI number — GLADYS MORENO RODRIGUEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLADYS MORENO RODRIGUEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LABORATORIO CLINICO LADERAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093941064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
T17 CALLE 10
Provider Second Line Business Mailing Address:
URB. SANTA JUANA 3
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-744-0777
Provider Business Mailing Address Fax Number:
787-744-0777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA # 1
Provider Second Line Business Practice Location Address:
KM. 26.9 SECTOR LA CHANGA , BARRIO RIO CANAS
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-6163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-744-0777
Provider Business Practice Location Address Fax Number:
787-744-0777
Provider Enumeration Date:
06/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORENO
Authorized Official First Name:
GLADYS
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST- OWNER
Authorized Official Telephone Number:
787-744-0777

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1187 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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