Provider Demographics
NPI:1093850604
Name:LABOROTORIO CLINICO Y BACTERIOLOGICO HATILLO INC
Entity Type:Organization
Organization Name:LABOROTORIO CLINICO Y BACTERIOLOGICO HATILLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT LIC 2750 OWNER
Authorized Official - Phone:787-820-9268
Mailing Address - Street 1:PO BOX 141394
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-820-9268
Mailing Address - Fax:787-820-9268
Practice Address - Street 1:CARR 119 KM 0.69 ESTANCIAS DE HATILLO
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-9268
Practice Address - Fax:787-820-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1011291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030585Medicare ID - Type Unspecified