Provider Demographics
NPI:1093709883
Name:LABORATORIO CLINICO MELANIA, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MELANIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-864-2763
Mailing Address - Street 1:PO BOX 1949
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1949
Mailing Address - Country:US
Mailing Address - Phone:787-864-2763
Mailing Address - Fax:787-864-9207
Practice Address - Street 1:CARRETERA NUMERO 3, KM 140.5
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-2763
Practice Address - Fax:787-864-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR988291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30005Medicare PIN