Provider Demographics
NPI:1508884545
Name:ALEX MUNIZ ALFONSO
Entity Type:Organization
Organization Name:ALEX MUNIZ ALFONSO
Other - Org Name:LABORATORIO CLINICO CAMASEYES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-997-5229
Mailing Address - Street 1:2704 RIO HONDO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-997-5229
Mailing Address - Fax:787-997-5229
Practice Address - Street 1:CARR. 459 K.M. 3.9
Practice Address - Street 2:CAMASEYES
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-997-5229
Practice Address - Fax:787-997-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1036291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031253OtherPTAN