Provider Demographics
NPI:1235553959
Name:ARACELIS MENDOZA
Entity Type:Organization
Organization Name:ARACELIS MENDOZA
Other - Org Name:LABORATORIO CLINICO ROYER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARACELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-887-7857
Mailing Address - Street 1:AA5 CALLE C
Mailing Address - Street 2:ALTURAS DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-3474
Mailing Address - Country:US
Mailing Address - Phone:787-887-7857
Mailing Address - Fax:787-887-7857
Practice Address - Street 1:AA-5 STREET C
Practice Address - Street 2:ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:P.R.
Practice Address - Zip Code:00745
Practice Address - Country:UM
Practice Address - Phone:787-887-7857
Practice Address - Fax:787-887-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0648291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40D0715747OtherCLIA