Provider Demographics
NPI:1942328059
Name:ROBINDRANATH PEREZ
Entity Type:Organization
Organization Name:ROBINDRANATH PEREZ
Other - Org Name:LABORATORIO CLINICO CAMPO ALEGRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBINDRANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-820-5371
Mailing Address - Street 1:PO BOX 140267
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0267
Mailing Address - Country:US
Mailing Address - Phone:787-820-5371
Mailing Address - Fax:787-820-5371
Practice Address - Street 1:CARRETERA 130 K.M.11.6
Practice Address - Street 2:BARRIO CAMPO ALEGRE
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-5371
Practice Address - Fax:787-820-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR701291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030066Medicare PIN