1205849924 NPI number — LABORATORIO CLINICO BARBOSA INC

Table of content: (NPI 1205849924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205849924 NPI number — LABORATORIO CLINICO BARBOSA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO BARBOSA 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:
Provider Other Organization Name Type Code:
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:
1205849924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#315 AVE BARBOSA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-2145
Provider Business Mailing Address Fax Number:
787-751-9253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 AVE BARBOSA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-2145
Provider Business Practice Location Address Fax Number:
787-751-9253
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSADO
Authorized Official First Name:
PORFIRIO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-767-2145

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  576 , 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)

  • Identifier: 20362 . This is a "PMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 61101 . This is a "HUMANA GOLD PLUS ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1204 . This is a "AMERICAN H. MEDICARE ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LA0124 . This is a "PALIC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0038294 . This is a "MEDICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 050989 . This is a "CRUZ AZUL PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: LB00576 . This is a "UIA PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 30361 . This is a "TRIPLE S PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9190041 . This is a "HUMANA PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 20217 . This is a "AMERICAN HEALTH ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400235 . This is a "UTI PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8333 . This is a "IMC PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 83294 . This is a "SDM PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 890117 . This is a "MMM PROVIDER ID" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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