Provider Demographics
NPI:1427036987
Name:LABORATORIO CLINICO RIO GRANDE, PSC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO RIO GRANDE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOLKA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PINERO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-887-8981
Mailing Address - Street 1:23 BDA LAS FLORES
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0001
Mailing Address - Country:US
Mailing Address - Phone:787-887-8981
Mailing Address - Fax:787-887-9356
Practice Address - Street 1:23 BDA LAS FLORES
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0001
Practice Address - Country:US
Practice Address - Phone:787-887-8981
Practice Address - Fax:787-887-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR709291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030881Medicare PIN