Provider Demographics
NPI:1508956319
Name:WAXALI INC
Entity Type:Organization
Organization Name:WAXALI INC
Other - Org Name:LABORATORIO CLINICO ISLA CENTRO NARANJITO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLLAZO ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-869-9585
Mailing Address - Street 1:HC 72 BOX 3954
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-8771
Mailing Address - Country:US
Mailing Address - Phone:787-869-9585
Mailing Address - Fax:787-869-0907
Practice Address - Street 1:# 43 CALLE IGNACIO MORALES ACOSTA
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-8771
Practice Address - Country:US
Practice Address - Phone:787-869-9585
Practice Address - Fax:787-869-0907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAXALI INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR594291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR594OtherSTATE
PR40D0658159OtherCLIA
PR594OtherSTATE