Provider Demographics
NPI:1780727776
Name:LUZ E. RODRIGUEZ LABORATORIO CLINICO GUARAGUAO
Entity type:Organization
Organization Name:LUZ E. RODRIGUEZ LABORATORIO CLINICO GUARAGUAO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-798-4747
Mailing Address - Street 1:AVE LOMAS VERDES 1C-14B
Mailing Address - Street 2:PMB 168
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-798-4747
Mailing Address - Fax:787-740-8395
Practice Address - Street 1:ROAD 174 KM 5.8
Practice Address - Street 2:BARRIO GUARAGUAO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-4747
Practice Address - Fax:787-740-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2485291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30967Medicare PIN