Provider Demographics
NPI:1225028996
Name:LABORATORIO CLINICO DEL MAR L.L.C
Entity Type:Organization
Organization Name:LABORATORIO CLINICO DEL MAR L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-406-1521
Mailing Address - Street 1:P.O. BOX 2221
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2221
Mailing Address - Country:US
Mailing Address - Phone:787-406-1521
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL PUERTA DEL SOL
Practice Address - Street 2:SUITE #2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-858-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR675291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38364Medicare PIN