Provider Demographics
NPI:1720258866
Name:AIXA E VEGA RODRIGUEZ
Entity Type:Organization
Organization Name:AIXA E VEGA RODRIGUEZ
Other - Org Name:LABORATORIO CLINICO PAJUIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TECHNOLOGY MEDICAL OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIXA
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MT
Authorized Official - Phone:787-820-5508
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1218
Mailing Address - Country:US
Mailing Address - Phone:787-820-5508
Mailing Address - Fax:
Practice Address - Street 1:CARR.490, KM3.5
Practice Address - Street 2:BO. PAJUIL
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1218
Practice Address - Country:US
Practice Address - Phone:787-820-5508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030954Medicare PIN