Provider Demographics
NPI:1366413932
Name:LABORATORIO CLINICO BAIROA INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BAIROA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-0330
Mailing Address - Street 1:2 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2606
Mailing Address - Country:US
Mailing Address - Phone:787-743-0330
Mailing Address - Fax:787-744-2588
Practice Address - Street 1:BAIROA AVE
Practice Address - Street 2:BAIROA SHOPPING CENTER C-2AVEAVE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1586
Practice Address - Country:US
Practice Address - Phone:787-746-1536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR502291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory