Provider Demographics
NPI:1467505776
Name:LABORATORIO CLINICO OLIVER
Entity Type:Organization
Organization Name:LABORATORIO CLINICO OLIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENA
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-878-5985
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-0734
Mailing Address - Country:US
Mailing Address - Phone:787-878-5985
Mailing Address - Fax:787-880-1529
Practice Address - Street 1:32 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4504
Practice Address - Country:US
Practice Address - Phone:787-878-5985
Practice Address - Fax:787-880-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR331291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038344Medicare PIN