Provider Demographics
NPI:1003364134
Name:RICHARD MIRANDA RODRIGUEZ
Entity Type:Organization
Organization Name:RICHARD MIRANDA RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO GALIZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-870-2200
Mailing Address - Street 1:A10 CALLE 1
Mailing Address - Street 2:VILLA MATILDE
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2304
Mailing Address - Country:US
Mailing Address - Phone:787-870-2200
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR-165 A10 CALLE 1
Practice Address - Street 2:VILLA MATILDE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2304
Practice Address - Country:US
Practice Address - Phone:787-870-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory