Provider Demographics
NPI:1154754752
Name:LABORATORIO CLINICO JARISELLE P.S.C
Entity type:Organization
Organization Name:LABORATORIO CLINICO JARISELLE P.S.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:JARINELLE
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-632-9550
Mailing Address - Street 1:RR3 BOX 10728
Mailing Address - Street 2:BO PINAS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-730-7777
Mailing Address - Fax:787-730-7777
Practice Address - Street 1:CARRETERA 829 KM 1.8
Practice Address - Street 2:BO PINAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-730-7777
Practice Address - Fax:787-730-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1172291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory