Provider Demographics
NPI:1306831318
Name:RIVERA MARCANO, CARMEN CERMIRA (BA NT ASCP)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:CERMIRA
Last Name:RIVERA MARCANO
Suffix:
Gender:F
Credentials:BA NT ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUNOZ RIVERA ST 5 SUR
Mailing Address - Street 2:LABORATORIO LICER
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-736-2951
Mailing Address - Fax:787-715-0170
Practice Address - Street 1:MUNOZ RIVERA ST 5 SUR
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-548-5816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1095246Z00000X, 246RM2200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38232Medicare ID - Type Unspecified
PR30259Medicare ID - Type Unspecified
PR38208Medicare ID - Type Unspecified