Provider Demographics
NPI:1548437221
Name:RODRIGUEZ ZAYAS, MARVI SAN (MT)
Entity type:Individual
Prefix:MRS
First Name:MARVI
Middle Name:SAN
Last Name:RODRIGUEZ ZAYAS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:LABORATORIO CLINICO JAYUYA
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0549
Mailing Address - Country:US
Mailing Address - Phone:787-828-6025
Mailing Address - Fax:787-828-2951
Practice Address - Street 1:5 CALLE FIGUERAS
Practice Address - Street 2:LABORATORIO CLINICO JAYUYA
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-1628
Practice Address - Country:US
Practice Address - Phone:787-828-6025
Practice Address - Fax:787-828-2951
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR542291U00000X
PR1550246QM0706X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38213OtherPROVIDER NUMBER
PR38213OtherPROVIDER NUMBER