Provider Demographics
NPI:1285038182
Name:LILLIAN I RIVERA OCASIO
Entity Type:Organization
Organization Name:LILLIAN I RIVERA OCASIO
Other - Org Name:LAB CLINICO DR AGUSTIN STAHL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIVERA OCASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-378-6957
Mailing Address - Street 1:21-20 CARR 174
Mailing Address - Street 2:URB SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-6512
Mailing Address - Country:US
Mailing Address - Phone:787-787-1691
Mailing Address - Fax:787-731-5642
Practice Address - Street 1:21-20 CARR 174
Practice Address - Street 2:URB SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6512
Practice Address - Country:US
Practice Address - Phone:787-787-1691
Practice Address - Fax:787-731-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR473291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory