Provider Demographics
NPI:1568448355
Name:LABORATORIO CLINICO Y BACTERIOLOGICO RODRIGUEZ INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO RODRIGUEZ INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-733-1404
Mailing Address - Street 1:100 CALLIE JOSE C BARBOSA
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-3927
Mailing Address - Country:US
Mailing Address - Phone:787-733-1404
Mailing Address - Fax:787-733-7788
Practice Address - Street 1:100 CALLIE JOSE C BARBOSA
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-3927
Practice Address - Country:US
Practice Address - Phone:787-733-1404
Practice Address - Fax:787-733-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR668291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR668OtherPR HEALTH DPT LICENSE
PR38240Medicare PIN