Provider Demographics
NPI:1710981501
Name:LARES MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:LARES MEDICAL CENTER INC.
Other - Org Name:LABORATORIO CLINICO QUEBRADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:BALTAZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-897-1444
Mailing Address - Street 1:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-897-1444
Mailing Address - Fax:787-897-4952
Practice Address - Street 1:CARR. 455 K 2.2
Practice Address - Street 2:BO. QUEBRADA
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-898-5665
Practice Address - Fax:787-898-5665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARES MEDICAL CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-09
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR717291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRX15465Medicare UPIN