Provider Demographics
NPI:1619007184
Name:LABORATORIO CLINICO Y BACTERIOLOGICO NAZARET
Entity Type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO NAZARET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-855-3652
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-2710
Mailing Address - Country:US
Mailing Address - Phone:787-855-3652
Mailing Address - Fax:787-807-7178
Practice Address - Street 1:113 CALLE MARGINAL
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4218
Practice Address - Country:US
Practice Address - Phone:787-855-3652
Practice Address - Fax:787-807-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR781291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030733Medicare ID - Type UnspecifiedPROVIDER