Provider Demographics
NPI:1518559210
Name:MRPV,LLC
Entity Type:Organization
Organization Name:MRPV,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEREZ VERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-638-0672
Mailing Address - Street 1:PO BOX 9020374
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0374
Mailing Address - Country:US
Mailing Address - Phone:787-638-0672
Mailing Address - Fax:
Practice Address - Street 1:113 CALLE MARGINAL
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4218
Practice Address - Country:US
Practice Address - Phone:787-665-0490
Practice Address - Fax:787-665-0492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MRPV,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1588273023Medicaid