Provider Demographics
NPI:1831182070
Name:LAB CLINICO BACTERIOLOGICO DEVAL
Entity type:Organization
Organization Name:LAB CLINICO BACTERIOLOGICO DEVAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:I
Authorized Official - Last Name:TALAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-846-0196
Mailing Address - Street 1:29 CARR 140
Mailing Address - Street 2:PO BOX 399
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2806
Mailing Address - Country:US
Mailing Address - Phone:787-846-0196
Mailing Address - Fax:787-846-0196
Practice Address - Street 1:29 CARR 140
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2806
Practice Address - Country:US
Practice Address - Phone:787-846-0196
Practice Address - Fax:787-846-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR996291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030099Medicare ID - Type UnspecifiedPROVIDER NUMBER