Provider Demographics
NPI:1144404450
Name:LABORATORIO CLINICO BAIROA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BAIROA
Other - Org Name:LABORATORIO CLINICO BORINQUEN-CAGUAS RALPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-744-0330
Mailing Address - Street 1:2 CALLE BALDORIOTY
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2606
Mailing Address - Country:US
Mailing Address - Phone:787-744-0330
Mailing Address - Fax:787-258-3286
Practice Address - Street 1:CARR. PR1, KM. 38.6, ESQ. CALLE 10, BO. BAIROA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2658
Practice Address - Country:US
Practice Address - Phone:787-747-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1130291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory