Provider Demographics
NPI:1922378975
Name:LABORATORIO CLINICO BETHANIA INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO BETHANIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-851-1007
Mailing Address - Street 1:PO BOX 1302
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1302
Mailing Address - Country:US
Mailing Address - Phone:787-255-2400
Mailing Address - Fax:
Practice Address - Street 1:61 CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-255-2400
Practice Address - Fax:787-255-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR789291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory