Provider Demographics
NPI:1558593467
Name:LABORATORIO CLINICO MARBELLA, INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MARBELLA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NITZA
Authorized Official - Middle Name:IMELLE
Authorized Official - Last Name:ORTIZ-FRANCESCHI
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MT(ASCP)
Authorized Official - Phone:787-486-0202
Mailing Address - Street 1:ATLANTIC VIEW COURT
Mailing Address - Street 2:APT 101
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-6363
Mailing Address - Fax:787-855-6363
Practice Address - Street 1:CARR PR-687 KM 0.7 INT URB CIUDAD REAL
Practice Address - Street 2:BO. ALGARROBO SECTOR TORTUGUERO 5
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-6363
Practice Address - Fax:787-855-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
40D1100145OtherCLIA ID