Provider Demographics
NPI:1205841756
Name:LABORATORIO CLINICO BACTERIOLOGICO CARIBBEAN, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BACTERIOLOGICO CARIBBEAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:787-798-2355
Mailing Address - Street 1:PO BOX 8571
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8571
Mailing Address - Country:US
Mailing Address - Phone:787-798-2355
Mailing Address - Fax:787-779-8305
Practice Address - Street 1:51-36 AVE MAIN
Practice Address - Street 2:SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6636
Practice Address - Country:US
Practice Address - Phone:787-798-2355
Practice Address - Fax:787-779-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR802291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
31475Medicare PIN