Provider Demographics
NPI:1902991615
Name:LABORATORIOS CLINICO BAYAMON INC
Entity Type:Organization
Organization Name:LABORATORIOS CLINICO BAYAMON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZORAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-780-4150
Mailing Address - Street 1:PO BOX 8544
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8544
Mailing Address - Country:US
Mailing Address - Phone:787-780-4150
Mailing Address - Fax:787-288-8207
Practice Address - Street 1:CALE PARQUE ESQUINA ROSSY EDIFICIO TRANSPORTACION PUBLI
Practice Address - Street 2:LOCAL 4C
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-780-4150
Practice Address - Fax:787-288-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR325291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38182Medicare ID - Type Unspecified