Provider Demographics
NPI:1942378450
Name:MARLYN RODRIGUEZ GINORIO
Entity Type:Organization
Organization Name:MARLYN RODRIGUEZ GINORIO
Other - Org Name:LABORATORIO CLINICO POL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MTASCP
Authorized Official - Phone:787-832-5040
Mailing Address - Street 1:9 CALLE DR BASORA N
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4893
Mailing Address - Country:US
Mailing Address - Phone:787-832-5040
Mailing Address - Fax:787-832-5040
Practice Address - Street 1:9 CALLE DR BASORA N
Practice Address - Street 2:SUITE # 2
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4893
Practice Address - Country:US
Practice Address - Phone:787-832-5040
Practice Address - Fax:787-832-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031553Medicare PIN