Provider Demographics
NPI:1134132392
Name:LABORATORIO CLINICO LUIS M RIVERA
Entity Type:Organization
Organization Name:LABORATORIO CLINICO LUIS M RIVERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:RIVERA ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-5620
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958
Mailing Address - Country:US
Mailing Address - Phone:787-883-5620
Mailing Address - Fax:787-883-1442
Practice Address - Street 1:CALLE LUIS M RIVERA NO 21
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-5620
Practice Address - Fax:787-883-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR231291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory