Provider Demographics
NPI:1396826780
Name:MEDITEST DIAGNOSTIC
Entity Type:Organization
Organization Name:MEDITEST DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-726-3724
Mailing Address - Street 1:PO BOX 8700
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0700
Mailing Address - Country:US
Mailing Address - Phone:787-726-3724
Mailing Address - Fax:787-726-3724
Practice Address - Street 1:700 CALLE DR PAVIA FERNANDEZ
Practice Address - Street 2:AVE. FERNANDEZ JUNCOS SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2758
Practice Address - Country:US
Practice Address - Phone:787-726-3724
Practice Address - Fax:787-726-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031370Medicare ID - Type UnspecifiedIDTF