Provider Demographics
NPI:1578759189
Name:DELMA RODRIGUEZ MORALES
Entity Type:Organization
Organization Name:DELMA RODRIGUEZ MORALES
Other - Org Name:LAB CLINICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIQUEZ MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT
Authorized Official - Phone:787-824-2845
Mailing Address - Street 1:VILLA DEL CARMEN
Mailing Address - Street 2:CALLE SICILIA 773
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-824-2845
Mailing Address - Fax:787-824-6921
Practice Address - Street 1:12 SANTIAGO PALMER
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-824-2845
Practice Address - Fax:787-824-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00518291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030915Medicare PIN