MEDICARE: LABORATORIOS BACO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	170	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20224	OTHER	PR	PREFERRED MEDICARE CHOICE

General Provider Information

NPI Number	:	1932378585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIOS BACO INC

Provider Business Mailing Address
First Line	:	22 CALLE PERAL N
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4821
Country	:	US
Telephone Number	:	787-832-7190
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 CALLE PERAL N
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-4821
Country	:	US
Telephone Number	:	787-832-7190
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JORGE B BACO
Credential	:	BSMT(ASCP)
Telephone Number	:	787-832-7190

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	11/27/2023

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