Provider Demographics
NPI:1609197656
Name:LABORATORIO CLINICO DEL ROSARIO, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL ROSARIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECNOLOGA MEDICA
Authorized Official - Prefix:MRS
Authorized Official - First Name:AYALA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZMIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-880-3690
Mailing Address - Street 1:1338 SUITE 1
Mailing Address - Street 2:BO. SANTANA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-880-3690
Mailing Address - Fax:787-880-3690
Practice Address - Street 1:CARR 2 KM 67.2
Practice Address - Street 2:BO. SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-3690
Practice Address - Fax:787-880-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031510Medicaid