Provider Demographics
NPI:1285020602
Name:MRPV,LLC
Entity Type:Organization
Organization Name:MRPV,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ VERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-638-0672
Mailing Address - Street 1:PO BOX 9020374
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0374
Mailing Address - Country:US
Mailing Address - Phone:787-638-0672
Mailing Address - Fax:787-966-7136
Practice Address - Street 1:29 CALLE ELLIOT VELEZ
Practice Address - Street 2:B 50
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4697
Practice Address - Country:US
Practice Address - Phone:787-921-7130
Practice Address - Fax:787-921-7132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRPV,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-13
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1238291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1588273023Medicaid