Provider Demographics
NPI:1093941064
Name:GLADYS MORENO RODRIGUEZ
Entity Type:Organization
Organization Name:GLADYS MORENO RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO LADERAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST- OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MT, ASCP
Authorized Official - Phone:787-744-0777
Mailing Address - Street 1:T17 CALLE 10
Mailing Address - Street 2:URB. SANTA JUANA 3
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2079
Mailing Address - Country:US
Mailing Address - Phone:787-744-0777
Mailing Address - Fax:787-744-0777
Practice Address - Street 1:CARRETERA # 1
Practice Address - Street 2:KM. 26.9 SECTOR LA CHANGA , BARRIO RIO CANAS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6163
Practice Address - Country:US
Practice Address - Phone:787-744-0777
Practice Address - Fax:787-744-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1187291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory