Provider Demographics
NPI:1114922291
Name:LABORATORIO CLINIC OMARIS INC
Entity Type:Organization
Organization Name:LABORATORIO CLINIC OMARIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCO
Authorized Official - Suffix:
Authorized Official - Credentials:BS MT ASCP
Authorized Official - Phone:787-262-7071
Mailing Address - Street 1:CARR PR-2 KM 86 HM 2 CALLE MARGINAL
Mailing Address - Street 2:4
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-262-7071
Mailing Address - Fax:
Practice Address - Street 1:CARR PR-2 KM 86 HM 2 CALLE MARGINAL
Practice Address - Street 2:262 SUITE 4
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-262-7071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1053291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031250Medicare ID - Type Unspecified