Provider Demographics
NPI:1598895856
Name:ADMINISTRACION DE LA LABORATORIO CLINICO INC
Entity Type:Organization
Organization Name:ADMINISTRACION DE LA LABORATORIO CLINICO INC
Other - Org Name:LABORATORIO CLINICO RODRIGUEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-878-1717
Mailing Address - Street 1:PO BOX 140297
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0297
Mailing Address - Country:US
Mailing Address - Phone:787-878-1717
Mailing Address - Fax:787-878-1717
Practice Address - Street 1:111 CALLE GONZALO MARIN
Practice Address - Street 2:BARRIO HATO ABAJO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4775
Practice Address - Country:US
Practice Address - Phone:787-878-1717
Practice Address - Fax:787-878-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR212291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031467Medicare ID - Type Unspecified