Provider Demographics
NPI:1881964955
Name:LABORATORIO CLINICO DR. GUALBERTO RABELL
Entity type:Organization
Organization Name:LABORATORIO CLINICO DR. GUALBERTO RABELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SUBDIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HCM
Authorized Official - Phone:787-480-3841
Mailing Address - Street 1:P.O. BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1405
Mailing Address - Country:US
Mailing Address - Phone:787-480-3876
Mailing Address - Fax:
Practice Address - Street 1:900 CALLE CERRA FINAL ESQUINA CALLE HOARE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1405
Practice Address - Country:US
Practice Address - Phone:787-480-3876
Practice Address - Fax:787-977-0544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO MAS SALUD DR GUALBERTO RABELL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR766291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9070138Medicaid
PR9070138Medicaid