Provider Demographics
NPI:1659481927
Name:JEANNETTE TOLEDO RODRIGUEZ
Entity Type:Organization
Organization Name:JEANNETTE TOLEDO RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO LECHUGA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPIETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-820-3183
Mailing Address - Street 1:HC 6 BOX 10560
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9527
Mailing Address - Country:US
Mailing Address - Phone:787-820-3183
Mailing Address - Fax:
Practice Address - Street 1:CARR 492 KM 0.1
Practice Address - Street 2:BO CAPAEZ SECTOR LECHUGA
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9527
Practice Address - Country:US
Practice Address - Phone:787-820-3183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR764291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030852Medicare PIN