Provider Demographics
NPI:1467468942
Name:ZORAIDA RODRIGUEZ CRUZ
Entity Type:Organization
Organization Name:ZORAIDA RODRIGUEZ CRUZ
Other - Org Name:LABORATORIO CLINICO CIUDAD UNIVERSITARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ZORAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGY
Authorized Official - Phone:787-755-2697
Mailing Address - Street 1:N16 CALLE AA
Mailing Address - Street 2:CIUDAD UNIVERSITARIA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00976 3119
Mailing Address - Country:UM
Mailing Address - Phone:787-755-2697
Mailing Address - Fax:787-283-3463
Practice Address - Street 1:N16 CALLE AA
Practice Address - Street 2:CIUDAD UNIVERSITARIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3130
Practice Address - Country:US
Practice Address - Phone:787-755-2697
Practice Address - Fax:787-761-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR493291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRX54891Medicare UPIN
PR30637Medicare PIN