Provider Demographics
NPI:1821071556
Name:CESAR A DEL VALLE & MAITE L ROLON
Entity Type:Organization
Organization Name:CESAR A DEL VALLE & MAITE L ROLON
Other - Org Name:LABORATORIO CLINICO ROLON
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAITE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLON
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:787-879-0749
Mailing Address - Street 1:PO BOX 142292
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2292
Mailing Address - Country:US
Mailing Address - Phone:787-879-0749
Mailing Address - Fax:787-816-4307
Practice Address - Street 1:CARR 490 KM 0 2
Practice Address - Street 2:BO HATO ARRIBA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-0749
Practice Address - Fax:787-816-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR886291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31024Medicare ID - Type Unspecified