Healthcare Provider Details

I. General information

NPI: 1912954470
Provider Name (Legal Business Name): LABORATORIO CLINICO EL ROSARIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE TRIO VEGABAJENO U-16 URB. EL ROSARIO
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 3031
VEGA ALTA PR
00692-3031
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-3434
  • Fax: 787-855-3434
Mailing address:
  • Phone: 787-855-3434
  • Fax: 787-855-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDIE G MONTANEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-553-0387