Provider Demographics
NPI:1083757694
Name:MB CLINICAL LABORATORIES EAST CORP.
Entity Type:Organization
Organization Name:MB CLINICAL LABORATORIES EAST CORP.
Other - Org Name:LABORATORIO CLINICO GURABO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-475-8731
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0476
Mailing Address - Country:US
Mailing Address - Phone:787-475-8731
Mailing Address - Fax:787-734-1927
Practice Address - Street 1:CALLE SANTIAGO NUM. 55
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-6042
Practice Address - Fax:787-737-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030979Medicare PIN