Provider Demographics
NPI:1265916605
Name:LABORATORIO CLINICO BARRAZAS INC
Entity type:Organization
Organization Name:LABORATORIO CLINICO BARRAZAS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MT
Authorized Official - Prefix:
Authorized Official - First Name:YADITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-776-1300
Mailing Address - Street 1:HC 645 BOX 6344
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-349-7841
Mailing Address - Fax:
Practice Address - Street 1:A2 AVENIDA ROBERTO SANCHEZ VILELLA
Practice Address - Street 2:CASTELLANA GARDEN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-985-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINICO BARRAZAS 2
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1376860635Medicaid