Healthcare Provider Details

I. General information

NPI: 1568448355
Provider Name (Legal Business Name): LABORATORIO CLINICO Y BACTERIOLOGICO RODRIGUEZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CALLIE JOSE C BARBOSA
LAS PIEDRAS PR
00771-3927
US

IV. Provider business mailing address

100 CALLIE JOSE C BARBOSA
LAS PIEDRAS PR
00771-3927
US

V. Phone/Fax

Practice location:
  • Phone: 787-733-1404
  • Fax: 787-733-7788
Mailing address:
  • Phone: 787-733-1404
  • Fax: 787-733-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number668
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. REINA M HERNANDEZ
Title or Position: DIRECTOR
Credential: MT
Phone: 787-733-1404