Provider Demographics
NPI:1124013123
Name:BRUNO RODRIGUEZ, INC
Entity Type:Organization
Organization Name:BRUNO RODRIGUEZ, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ PANTOJE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MT
Authorized Official - Phone:787-854-2277
Mailing Address - Street 1:PMB 160
Mailing Address - Street 2:PO BOX 30500
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-3050
Mailing Address - Country:US
Mailing Address - Phone:787-854-2277
Mailing Address - Fax:787-884-4281
Practice Address - Street 1:AVE COLON #4
Practice Address - Street 2:SUITE #3
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-3050
Practice Address - Country:US
Practice Address - Phone:787-854-2277
Practice Address - Fax:787-884-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR239291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR003-1422Medicare PIN