Provider Demographics
NPI:1588006704
Name:MAYAGUEZ CLINICAL LAB, INC.
Entity Type:Organization
Organization Name:MAYAGUEZ CLINICAL LAB, INC.
Other - Org Name:MAS CLINICAL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-4376
Mailing Address - Street 1:PERAL 27
Mailing Address - Street 2:EDIFICIO DOCTORS CENTER
Mailing Address - City:MAYAGUEZ, PR
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4894
Mailing Address - Country:US
Mailing Address - Phone:787-832-4376
Mailing Address - Fax:787-827-9300
Practice Address - Street 1:27 CALLE PERAL N STE 107
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4820
Practice Address - Country:US
Practice Address - Phone:787-832-4376
Practice Address - Fax:787-827-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR478291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory