Provider Demographics
NPI:1639173099
Name:LABORATORIO CLINICO JAYUYA, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO JAYUYA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ DUENA
Authorized Official - Prefix:
Authorized Official - First Name:MARVI
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-828-6025
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0549
Mailing Address - Country:US
Mailing Address - Phone:787-828-6025
Mailing Address - Fax:787-828-2951
Practice Address - Street 1:5 CALLE FIGUERAS
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1407
Practice Address - Country:US
Practice Address - Phone:787-828-6025
Practice Address - Fax:787-828-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR542291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038213Medicare PIN