Provider Demographics
NPI:1174803894
Name:LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS II
Entity type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-839-9393
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-0986
Mailing Address - Country:US
Mailing Address - Phone:787-839-9393
Mailing Address - Fax:787-839-9344
Practice Address - Street 1:CARR NUM 3
Practice Address - Street 2:KM 122 HM 6
Practice Address - City:PATILLAS
Practice Address - State:PR
Practice Address - Zip Code:00723
Practice Address - Country:US
Practice Address - Phone:787-839-9393
Practice Address - Fax:787-839-9344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO Y BACTERIOLOGICO GENESIS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1226291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031132OtherMEDICARE ID-TYPE UNSPECIFIED