Provider Demographics
NPI:1467892604
Name:LABORATORIO CLINICO MARTIN INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MARTIN INC
Other - Org Name:LABORATORIO CLINICO MARTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-2131
Mailing Address - Street 1:M5 AVE COLECTORA CENTRAL URB JARDINES DE CAPARRA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-707-8504
Mailing Address - Fax:787-706-8194
Practice Address - Street 1:M5 AVE COLECTORA CENTRAL
Practice Address - Street 2:URB JARDINES DE CAPARRA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-707-8504
Practice Address - Fax:787-706-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1285291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHN842AMedicare PIN