Provider Demographics
NPI:1093702771
Name:LABORATORIO CLINICO MUNOZ RIVERA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MUNOZ RIVERA INC
Other - Org Name:LABORATORIO CLINICO MUNOZ RIVERA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-720-5462
Mailing Address - Street 1:# 51 ESMERALDA AVENUE,
Mailing Address - Street 2:URBANIZACION MUNOZ RIVERA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-720-5462
Mailing Address - Fax:787-720-0745
Practice Address - Street 1:# 51 ESMERALDA AVE,
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0000
Practice Address - Country:US
Practice Address - Phone:787-720-5462
Practice Address - Fax:787-720-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38349Medicare ID - Type Unspecified