Provider Demographics
NPI:1336223189
Name:VINCENTE CALDERON RODRIGUEZ
Entity Type:Organization
Organization Name:VINCENTE CALDERON RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO VALPARAISO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-261-1169
Mailing Address - Street 1:PO BOX 6085
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6085
Mailing Address - Country:US
Mailing Address - Phone:787-261-1169
Mailing Address - Fax:
Practice Address - Street 1:JR1 CALLE LIZZIE GRAHAM
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3637
Practice Address - Country:US
Practice Address - Phone:787-261-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR612291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31097Medicare PIN