Provider Demographics
NPI:1922144609
Name:MARISOL CALLAZO ORTIZ INC
Entity Type:Organization
Organization Name:MARISOL CALLAZO ORTIZ INC
Other - Org Name:LABORATORIO CLINICO MICROBIOLOGICO PUERTO RICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MS MT
Authorized Official - Phone:7877-387-5556
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1700
Mailing Address - Country:US
Mailing Address - Phone:787-738-7556
Mailing Address - Fax:787-738-1515
Practice Address - Street 1:AVENIDA LUIS MUNOZ MARIN #11
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7556
Practice Address - Fax:787-738-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR746291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0877OtherINTERNATIONAL MEDICAL CAR
15843OtherAMPR
20463OtherAMERICAN HEALTH
30646OtherTRIPLE S
20213OtherPREFERRED MEDICARE CHOICE
400123OtherPREFERRED HEALTH UTI
6330044OtherHUMANA REFORMA
6330044OtherHUMANA HEALTH PLAN
LB00746OtherUIA
051387OtherLA CRUZ AZUL DE PUERTO RI
6330044OtherHUMANA INSURANCE
20463OtherAMERICAN HEALTH
6330044OtherHUMANA REFORMA