Provider Demographics
NPI:1205849924
Name:LABORATORIO CLINICO BARBOSA INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BARBOSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PORFIRIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:787-767-2145
Mailing Address - Street 1:#315 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3306
Mailing Address - Country:US
Mailing Address - Phone:787-767-2145
Mailing Address - Fax:787-751-9253
Practice Address - Street 1:315 AVE BARBOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3306
Practice Address - Country:US
Practice Address - Phone:787-767-2145
Practice Address - Fax:787-751-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR576291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20362OtherPMC PROVIDER ID
PR61101OtherHUMANA GOLD PLUS ID
PR1204OtherAMERICAN H. MEDICARE ID
PRLA0124OtherPALIC PROVIDER ID
PR0038294OtherMEDICARE
PR050989OtherCRUZ AZUL PROVIDER ID
PRLB00576OtherUIA PROVIDER ID
PR30361OtherTRIPLE S PROVIDER ID
PR9190041OtherHUMANA PROVIDER ID
PR20217OtherAMERICAN HEALTH ID
PR400235OtherUTI PROVIDER ID
PR8333OtherIMC PROVIDER ID
PR83294OtherSDM PROVIDER ID
PR890117OtherMMM PROVIDER ID
PR=========OtherMAPFRE PROVIDER ID
PRLA0124OtherPALIC PROVIDER ID
PR1204OtherAMERICAN H. MEDICARE ID
PRLB00576OtherUIA PROVIDER ID