Provider Demographics
NPI:1639615917
Name:LABORATORIO CLNICO Y BACTERIOLOGICO RODRIGUEZ INC
Entity Type:Organization
Organization Name:LABORATORIO CLNICO Y BACTERIOLOGICO RODRIGUEZ INC
Other - Org Name:LABORATORIO CLINICO PITAHAYA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-733-1404
Mailing Address - Street 1:100 CALLE JOSE C BARBOSA
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771
Mailing Address - Country:US
Mailing Address - Phone:787-733-1404
Mailing Address - Fax:
Practice Address - Street 1:CARR PR 924 KM 2
Practice Address - Street 2:HM 8
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-7722
Practice Address - Fax:787-733-7788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO Y BACTERIOLOGICO RODRIGUEZ INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-11
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1165291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1165OtherSTATE LIC
PR40D1086589OtherCLIA