Provider Demographics
NPI:1760524714
Name:RODOLFO DIAZ TORRES SR
Entity Type:Organization
Organization Name:RODOLFO DIAZ TORRES SR
Other - Org Name:LABORATORIO CLINICO COTO LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-844-5788
Mailing Address - Street 1:PO BOX 800544
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0544
Mailing Address - Country:US
Mailing Address - Phone:787-844-5788
Mailing Address - Fax:787-651-7301
Practice Address - Street 1:99 CARR 14
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-844-5788
Practice Address - Fax:787-651-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR824291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory