1306928684 NPI number — LABORATORIO CLINICO RODRIGUEZ STELLA INC

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 1306928684 NPI number — LABORATORIO CLINICO RODRIGUEZ STELLA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO RODRIGUEZ STELLA INC
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 COSTA CARIBE
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:
1306928684
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2610 MAYOR STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00717-2074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-843-2251
Provider Business Mailing Address Fax Number:
787-843-2251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 MAYOR STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-2074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-843-2251
Provider Business Practice Location Address Fax Number:
787-843-2251
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ IRIZARRY
Authorized Official First Name:
DAMIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-808-4040

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  0428 , 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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