MEDICARE: LABORATORIO CLINICO BARBOSA 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	576	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1204	OTHER	PR	AMERICAN H. MEDICARE ID
5	0038294	OTHER	PR	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20362	OTHER	PR	PMC PROVIDER ID
2	61101	OTHER	PR	HUMANA GOLD PLUS ID
4	LA0124	OTHER	PR	PALIC PROVIDER ID
6	050989	OTHER	PR	CRUZ AZUL PROVIDER ID
7	LB00576	OTHER	PR	UIA PROVIDER ID
8	30361	OTHER	PR	TRIPLE S PROVIDER ID
9	9190041	OTHER	PR	HUMANA PROVIDER ID
10	20217	OTHER	PR	AMERICAN HEALTH ID
11	400235	OTHER	PR	UTI PROVIDER ID
12	8333	OTHER	PR	IMC PROVIDER ID
13	83294	OTHER	PR	SDM PROVIDER ID
14	890117	OTHER	PR	MMM PROVIDER ID

General Provider Information

NPI Number	:	1205849924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO BARBOSA INC

Provider Business Mailing Address
First Line	:	#315 AVE BARBOSA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3306
Country	:	US
Telephone Number	:	787-767-2145
Fax Number	:	787-751-9253

Provider Business Practice Location Address
First Line	:	315 AVE BARBOSA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-3306
Country	:	US
Telephone Number	:	787-767-2145
Fax Number	:	787-751-9253

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PORFIRIO ROSADO JR.
Credential	:	R.N.
Telephone Number	:	787-767-2145

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/03/2015

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