Provider Demographics
NPI:1376525444
Name:LABORATORIO CLINICO RIVERA INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO RIVERA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-894-8718
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ANGELES
Mailing Address - State:PR
Mailing Address - Zip Code:00611-0370
Mailing Address - Country:US
Mailing Address - Phone:787-894-8718
Mailing Address - Fax:787-894-8718
Practice Address - Street 1:CARRETERA III INTERSECTION 602
Practice Address - Street 2:KM .6 BO ANGELES
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00611-0370
Practice Address - Country:US
Practice Address - Phone:787-894-8718
Practice Address - Fax:787-894-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR905291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31150Medicare ID - Type Unspecified