Provider Demographics
NPI:1518939081
Name:DAVID VELAZQUEZ CAMARENA LABORATORIO CLINICO DAJAOS
Entity Type:Organization
Organization Name:DAVID VELAZQUEZ CAMARENA LABORATORIO CLINICO DAJAOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PRADOS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-730-1195
Mailing Address - Street 1:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1815
Mailing Address - Country:US
Mailing Address - Phone:787-786-6209
Mailing Address - Fax:787-269-1378
Practice Address - Street 1:CARR 167 # KM11.0
Practice Address - Street 2:BO. DAJAOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9212
Practice Address - Country:US
Practice Address - Phone:787-730-1195
Practice Address - Fax:787-730-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR616291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031290OtherMEDICARE PROVIDER