Provider Demographics
NPI:1447323605
Name:ROSALINA ALICEA ORTIZ
Entity type:Organization
Organization Name:ROSALINA ALICEA ORTIZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:MT MEDICAL TECHNOLOG
Authorized Official - Phone:787-712-0455
Mailing Address - Street 1:1664 DAKOTA
Mailing Address - Street 2:SAN GERARDO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-712-0455
Mailing Address - Fax:787-712-0455
Practice Address - Street 1:CARR 181 KM 23
Practice Address - Street 2:BARRIO CELADA
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-712-0455
Practice Address - Fax:787-712-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCLIA#40D0972366291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory