Provider Demographics
NPI:1174828412
Name:DIAZ BONET INC
Entity Type:Organization
Organization Name:DIAZ BONET INC
Other - Org Name:LABORATORIO CLINICO BONET HERNANDEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONET
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-600-0321
Mailing Address - Street 1:P O BOX 1173
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-1173
Mailing Address - Country:US
Mailing Address - Phone:787-600-0321
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 55.1
Practice Address - Street 2:BO PALENQUE
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-600-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHL231AOtherMEDICARE PTAN