Provider Demographics
NPI:1407024391
Name:AILEEN RAMOS RIVERA
Entity Type:Organization
Organization Name:AILEEN RAMOS RIVERA
Other - Org Name:LABORATORIO CLINICO GENESIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MEDICAL TECHNOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-265-2336
Mailing Address - Street 1:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1885
Mailing Address - Country:US
Mailing Address - Phone:787-265-2336
Mailing Address - Fax:787-834-6058
Practice Address - Street 1:CALLE NESTOR TORRES 31
Practice Address - Street 2:
Practice Address - City:POBLADO ROSARIO
Practice Address - State:PR
Practice Address - Zip Code:00636-0782
Practice Address - Country:US
Practice Address - Phone:787-265-2336
Practice Address - Fax:787-834-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR884291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31244Medicare PIN