Provider Demographics
NPI:1265819536
Name:SOUTHERN REGIONAL BLOOD BANK
Entity Type:Organization
Organization Name:SOUTHERN REGIONAL BLOOD BANK
Other - Org Name:PUERTO RICO BLOOD BANK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:787-841-8645
Mailing Address - Street 1:PO BOX 10729
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732
Mailing Address - Country:US
Mailing Address - Phone:787-841-8645
Mailing Address - Fax:787-848-4043
Practice Address - Street 1:234-A PARQUE INDUSTRIAL SABANETA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-841-8645
Practice Address - Fax:787-848-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1296331L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes331L00000XSuppliersBlood Bank