Provider Demographics
NPI:1568473171
Name:MARIA TERESA NIEVES RODRIGUEZ
Entity Type:Organization
Organization Name:MARIA TERESA NIEVES RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO JUANA DIAZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:787-837-6420
Mailing Address - Street 1:CALLE LA CRUZ #3
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-837-6420
Mailing Address - Fax:787-260-0570
Practice Address - Street 1:609 AVE TITO CASTRO
Practice Address - Street 2:ST 102 PMB 353
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0200
Practice Address - Country:US
Practice Address - Phone:787-837-6420
Practice Address - Fax:787-260-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1063291U00000X
PR40D1003673291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPROVIDER NUMBER
PR=========OtherPROVIDER NUMBER