Provider Demographics
NPI:1013375591
Name:BETA LAB
Entity Type:Organization
Organization Name:BETA LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CARMEN
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-613-1942
Mailing Address - Street 1:COND. PLAZA DEL PARQUE
Mailing Address - Street 2:ED 8 APT C-1
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2089
Mailing Address - Country:US
Mailing Address - Phone:787-613-1942
Mailing Address - Fax:
Practice Address - Street 1:C/ 601 BLOQUE 222 # 18
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-2083
Practice Address - Country:US
Practice Address - Phone:787-613-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8263291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory