Provider Demographics
NPI:1558339366
Name:LABORATORIO CLINICO ROXELL INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO ROXELL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-852-2680
Mailing Address - Street 1:104 CALLE FONT MARTELO E
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-8500
Mailing Address - Country:US
Mailing Address - Phone:787-852-2680
Mailing Address - Fax:787-852-6443
Practice Address - Street 1:104 CALLE FONT MARTELO E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3946
Practice Address - Country:US
Practice Address - Phone:787-852-2680
Practice Address - Fax:787-852-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR384291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038237Medicare ID - Type UnspecifiedPROVIDER NUMBER