Provider Demographics
NPI:1083210470
Name:LABORATORIO CLINICO JARISELLE P.S.C
Entity Type:Organization
Organization Name:LABORATORIO CLINICO JARISELLE P.S.C
Other - Org Name:LABORATORIO CLINICO JARISELLE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:JARINELLE
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-730-7777
Mailing Address - Street 1:RR 3 BOX 10728-1
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-6453
Mailing Address - Country:US
Mailing Address - Phone:787-730-7777
Mailing Address - Fax:
Practice Address - Street 1:CARR 167 KM 10.6
Practice Address - Street 2:BO DAJAOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-730-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO JARISELLE PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory