Provider Demographics
NPI:1275866964
Name:M R REFERENCE LABORATORIES
Entity Type:Organization
Organization Name:M R REFERENCE LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-653-5589
Mailing Address - Street 1:704 CALLE MERIDA
Mailing Address - Street 2:VILLAS DEL SOL
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5113
Mailing Address - Country:US
Mailing Address - Phone:787-768-8084
Mailing Address - Fax:787-653-5589
Practice Address - Street 1:11 AVE INDUSTRIAL
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5043
Practice Address - Country:US
Practice Address - Phone:787-738-7556
Practice Address - Fax:787-738-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005749291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory