Provider Demographics
NPI:1083690721
Name:ROSA RODRIGUEZ LABORATORIO CLINICO SULTANA
Entity Type:Organization
Organization Name:ROSA RODRIGUEZ LABORATORIO CLINICO SULTANA
Other - Org Name:LABORATORIO SULTANA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-833-4454
Mailing Address - Street 1:1159 CALLE MAGNOLIA
Mailing Address - Street 2:URB BUENA VENTURA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1284
Mailing Address - Country:US
Mailing Address - Phone:787-833-4454
Mailing Address - Fax:787-833-4454
Practice Address - Street 1:1159 CALLE MAGNOLIA
Practice Address - Street 2:URB BUENA VENTURA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1284
Practice Address - Country:US
Practice Address - Phone:787-833-4454
Practice Address - Fax:787-833-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR461291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30435Medicare ID - Type UnspecifiedACTUAL PROVIDER NUMBER