Provider Demographics
NPI:1629201157
Name:BAHIA MEDICAL LABORATORIES INC
Entity Type:Organization
Organization Name:BAHIA MEDICAL LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-275-8166
Mailing Address - Street 1:AVE. BARBOSA # 69
Mailing Address - Street 2:
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962-4844
Mailing Address - Country:US
Mailing Address - Phone:787-275-8166
Mailing Address - Fax:
Practice Address - Street 1:AVE. BARBOSA # 69
Practice Address - Street 2:
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-4844
Practice Address - Country:US
Practice Address - Phone:787-275-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIDRA MEDICAL LAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-01
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1197291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory