Provider Demographics
NPI:1306156310
Name:BETHZAIDA MATIAS LABORATORIO CLINICO TU SALUD
Entity type:Organization
Organization Name:BETHZAIDA MATIAS LABORATORIO CLINICO TU SALUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BETHZAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-868-3884
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2023
Mailing Address - Country:US
Mailing Address - Phone:787-868-3884
Mailing Address - Fax:787-868-3884
Practice Address - Street 1:CARR 417 KM 4.2
Practice Address - Street 2:BO MAMEY
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-3884
Practice Address - Fax:787-868-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D2007082291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory