=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376860635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO BARRAZAS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2010
-----------------------------------------------------
Last Update Date | 08/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ROAD 853 KM 11.4
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-776-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 645 BOX 6344
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-9749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-509-0729
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MT
-----------------------------------------------------
Name | YADITH DEL VALLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-776-1300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 1216
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------