Provider Demographics
NPI:1275645988
Name:LABORATORIO CLINICO PLAZA DEL NORTE INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO PLAZA DEL NORTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RODRIGUEZ-BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS MT
Authorized Official - Phone:787-878-1359
Mailing Address - Street 1:PO BOX 2137
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613
Mailing Address - Country:US
Mailing Address - Phone:787-878-1359
Mailing Address - Fax:787-878-1359
Practice Address - Street 1:CALLE LA MILITAR NO 517
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-878-1359
Practice Address - Fax:787-878-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR916291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031165Medicare PIN