Provider Demographics
NPI:1598833931
Name:LABORATORIO CLINICO BELLA VISTA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BELLA VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:ZAMBRANA
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-797-1190
Mailing Address - Street 1:LOCAL 18A BLD. #4
Mailing Address - Street 2:CENTRO COMERCIAL BELLA VISTA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-797-1190
Mailing Address - Fax:787-797-1190
Practice Address - Street 1:LOCAL 18A BLD. #4
Practice Address - Street 2:CENTRO COMERCIAL BELLA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-797-1190
Practice Address - Fax:787-797-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR796291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30760Medicare ID - Type Unspecified