Provider Demographics
NPI:1043595341
Name:METRO PAVIA HEALTHCARE CENTERS INC
Entity Type:Organization
Organization Name:METRO PAVIA HEALTHCARE CENTERS INC
Other - Org Name:LABORATORIO CLINICO METROPAVIA CLINIC ARECIBO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSP ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-650-0090
Mailing Address - Street 1:PO BOX 9976
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9976
Mailing Address - Country:US
Mailing Address - Phone:787-650-0020
Mailing Address - Fax:787-650-0922
Practice Address - Street 1:CARR 129
Practice Address - Street 2:ZONA INDUSTRIAL VICTOR ROJAS II
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-0020
Practice Address - Fax:787-650-0098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO PAVIA HEALTHCARE CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-18
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1039291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1039OtherSTATE LICENSE
PR40D0992949OtherCLIA