Provider Demographics
NPI:1700077765
Name:LABORATORIO CLINICO RURAL TRUJILLO ALTO
Entity Type:Organization
Organization Name:LABORATORIO CLINICO RURAL TRUJILLO ALTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOYTIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS MT ASCP
Authorized Official - Phone:787-760-4500
Mailing Address - Street 1:PO BOX 1468
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1468
Mailing Address - Country:US
Mailing Address - Phone:787-760-4500
Mailing Address - Fax:787-283-2950
Practice Address - Street 1:RD. 181 KM 8.6
Practice Address - Street 2:BO. DOS BOCAS
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977
Practice Address - Country:US
Practice Address - Phone:787-760-4500
Practice Address - Fax:787-283-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR852291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory