Provider Demographics
NPI:1184676603
Name:MYRNA LIZ BELTRAN
Entity Type:Organization
Organization Name:MYRNA LIZ BELTRAN
Other - Org Name:LABORATORIO CLINICO VILLA ANA LAS 400'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-876-0400
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:787-876-0400
Mailing Address - Fax:787-876-0400
Practice Address - Street 1:ROAD 185 KM. 18.5
Practice Address - Street 2:BO. CEDROS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-876-0400
Practice Address - Fax:787-876-0400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYRNA LIZ BELTRAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR977291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31466Medicare ID - Type UnspecifiedPROVIDER NUMBER