Provider Demographics
NPI:1467486019
Name:COMERIO MEDICAL HOSPITAL INC
Entity Type:Organization
Organization Name:COMERIO MEDICAL HOSPITAL INC
Other - Org Name:COMERIO MEDICAL CENTER LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-316-1212
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782-1103
Mailing Address - Country:US
Mailing Address - Phone:787-875-3136
Mailing Address - Fax:787-875-4904
Practice Address - Street 1:STREET 778 KM 0.9 BO PASARELL
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782
Practice Address - Country:US
Practice Address - Phone:787-875-3136
Practice Address - Fax:787-875-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1062291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31374Medicare ID - Type UnspecifiedLABORATORY