Provider Demographics
NPI:1639164841
Name:LABORATORIO CLINICO RINCON PSC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO RINCON PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUREA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-823-4527
Mailing Address - Street 1:CALLE MUNOZ RIVERA 53 OESTE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677
Mailing Address - Country:US
Mailing Address - Phone:787-823-4527
Mailing Address - Fax:787-823-4527
Practice Address - Street 1:CALLE MUNOZ RIVERA 53 OESTE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-823-4527
Practice Address - Fax:787-823-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR397291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30952Medicare ID - Type Unspecified