1154754752 NPI number — LABORATORIO CLINICO JARISELLE P.S.C

Table of content: ANDREW WILLIAM BENDER MD (NPI 1326083312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154754752 NPI number — LABORATORIO CLINICO JARISELLE P.S.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO JARISELLE P.S.C
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:
Provider Other Organization Name Type Code:
6
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:
1154754752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RR3 BOX 10728
Provider Second Line Business Mailing Address:
BO PINAS
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-730-7777
Provider Business Mailing Address Fax Number:
787-730-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 829 KM 1.8
Provider Second Line Business Practice Location Address:
BO PINAS
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-730-7777
Provider Business Practice Location Address Fax Number:
787-730-7777
Provider Enumeration Date:
08/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
BRIDGET
Authorized Official Middle Name:
JARINELLE
Authorized Official Title or Position:
MEDICAL TECHNOLOGIST
Authorized Official Telephone Number:
787-632-9550

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1172 , 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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