Provider Demographics
NPI:1750573200
Name:LABORATORIO CLINICO Y BACTERIOLOGICO GLADYAN INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO Y BACTERIOLOGICO GLADYAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORRES-AZIZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-266-3500
Mailing Address - Street 1:CALLE CATALINA MORALES
Mailing Address - Street 2:NO 5 SUITE #2
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-266-3300
Mailing Address - Fax:787-266-3500
Practice Address - Street 1:CALLE CATALINA MORALES
Practice Address - Street 2:NO 5 SUITE #2
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-266-3300
Practice Address - Fax:787-266-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1132291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory