Provider Demographics
NPI:1063240067
Name:LABORATORIO CLINICO MIGRANT SAN GERMAN
Entity type:Organization
Organization Name:LABORATORIO CLINICO MIGRANT SAN GERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-831-5800
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0190
Mailing Address - Country:US
Mailing Address - Phone:787-831-5800
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA UNIVERSIDAD INTERAMERICANA #158
Practice Address - Street 2:BO PUEBLO SAN GERMAN
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory