Provider Demographics
NPI:1750462362
Name:LABORATORIO CLINICO DEL ROSARIO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL ROSARIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAZMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-880-3690
Mailing Address - Street 1:1338
Mailing Address - Street 2:SUITE I, BO SANTANA
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-880-3690
Mailing Address - Fax:787-880-3690
Practice Address - Street 1:1338
Practice Address - Street 2:SUITE I, BO SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-880-3690
Practice Address - Fax:787-880-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1101291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31510Medicare ID - Type Unspecified