Provider Demographics
NPI:1407865363
Name:LABORATORIO CLINICO EL MONTE
Entity Type:Organization
Organization Name:LABORATORIO CLINICO EL MONTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-764-0445
Mailing Address - Street 1:650 AVE MUNOZ RIVERA
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4110
Mailing Address - Country:US
Mailing Address - Phone:787-764-0445
Mailing Address - Fax:787-754-2203
Practice Address - Street 1:650 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4110
Practice Address - Country:US
Practice Address - Phone:787-764-0445
Practice Address - Fax:787-754-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR202291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
0038246Medicare PIN