Provider Demographics
NPI:1548431067
Name:POU, MARLEN J
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:J
Last Name:POU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 194690
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4690
Mailing Address - Country:US
Mailing Address - Phone:787-783-5686
Mailing Address - Fax:787-707-0818
Practice Address - Street 1:12 CALLE BUEN SAMARITANO
Practice Address - Street 2:BO J DOMINGO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-7934
Practice Address - Country:US
Practice Address - Phone:787-783-5686
Practice Address - Fax:787-707-0818
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR552291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030506Medicare PIN