Provider Demographics
NPI:1386634152
Name:LABORATORIO CLINICO BAYAMON OESTE INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BAYAMON OESTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROLON
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-778-8574
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-0736
Mailing Address - Country:US
Mailing Address - Phone:787-778-8574
Mailing Address - Fax:787-778-8574
Practice Address - Street 1:BAYAMON OESTE SHOPP CTR
Practice Address - Street 2:33
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4784
Practice Address - Country:US
Practice Address - Phone:787-778-8574
Practice Address - Fax:787-778-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31324Medicare ID - Type Unspecified