Provider Demographics
NPI:1023347507
Name:LABORATORIO CLINICO BELLA VISTA DE CIALES INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BELLA VISTA DE CIALES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-871-1775
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-1328
Mailing Address - Country:US
Mailing Address - Phone:787-871-1775
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR 149 KM 17.9
Practice Address - Street 2:BARRIO PESAS SECTOR BELLA VISTA
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory