=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568448355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO Y BACTERIOLOGICO RODRIGUEZ INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 06/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CALLIE JOSE C BARBOSA
-----------------------------------------------------
City | LAS PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00771-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-733-1404
-----------------------------------------------------
Fax | 787-733-7788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CALLIE JOSE C BARBOSA
-----------------------------------------------------
City | LAS PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00771-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-733-1404
-----------------------------------------------------
Fax | 787-733-7788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. REINA M HERNANDEZ
-----------------------------------------------------
Credential | MT
-----------------------------------------------------
Telephone | 787-733-1404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 668
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------