1639615917 NPI number — LABORATORIO CLNICO Y BACTERIOLOGICO RODRIGUEZ INC

Table of content: (NPI 1639615917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639615917 NPI number — LABORATORIO CLNICO Y BACTERIOLOGICO RODRIGUEZ INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLNICO Y BACTERIOLOGICO RODRIGUEZ 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:
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:
1639615917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CALLE JOSE C BARBOSA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-733-1404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR PR 924 KM 2
Provider Second Line Business Practice Location Address:
HM 8
Provider Business Practice Location Address City Name:
HUMACAO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-852-7722
Provider Business Practice Location Address Fax Number:
787-733-7788
Provider Enumeration Date:
01/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
REINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
LAB DIRECTOR
Authorized Official Telephone Number:
787-733-1404

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  1165 , 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: 1165 . This is a "STATE LIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 40D1086589 . This is a "CLIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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