Provider Demographics
NPI:1407407018
Name:LABORATORIO CLINICO J RODRIGUEZ, LLC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO J RODRIGUEZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERIMER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ-VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-506-0994
Mailing Address - Street 1:23 CALLE FRANCISCO M QUINONEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1942
Mailing Address - Country:US
Mailing Address - Phone:787-873-2721
Mailing Address - Fax:787-873-2557
Practice Address - Street 1:23 CALLE FRANCISCO M QUINONEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1942
Practice Address - Country:US
Practice Address - Phone:787-873-2721
Practice Address - Fax:787-873-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
291U00000XOtherTAXONOMY