Provider Demographics
NPI:1043398241
Name:CIDRA MEDICAL LABS INC
Entity Type:Organization
Organization Name:CIDRA MEDICAL LABS INC
Other - Org Name:LAB CLINICO CARIBE
Other - Org Type:Other Name
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BSMT ACSP
Authorized Official - Phone:787-747-7042
Mailing Address - Street 1:8 CALLE GAUTIER BENITEZ
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3338
Mailing Address - Country:US
Mailing Address - Phone:787-739-4747
Mailing Address - Fax:787-714-0522
Practice Address - Street 1:8 CALLE GAUTIER BENITEZ
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3338
Practice Address - Country:US
Practice Address - Phone:787-739-4747
Practice Address - Fax:787-714-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038324Medicare PIN