Basic Information
| Provider Information | |||||||||
| NPI: | 1659415776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LABORATORIO CLINICO ESPECIALIZADO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60327 | ||||||||
| Address2: | |||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009606032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
| FaxNumber: | 7877984990 | ||||||||
| Practice Location | |||||||||
| Address1: | AVENIDA SANTA JUANITA | ||||||||
| Address2: | ESQUINA LAURAL #100 | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009606032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877983001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ IRIZARRY | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT INTERINO UCC | ||||||||
| AuthorizedOfficialTelephone: | 7877983001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.