Provider Demographics
NPI:1629064258
Name:UNIVERSAL MEDICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL LABORATORIES, INC.
Other - Org Name:UNIVERSAL MEDICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-763-3992
Mailing Address - Street 1:PO BOX 362842
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2842
Mailing Address - Country:US
Mailing Address - Phone:787-763-3992
Mailing Address - Fax:787-771-6592
Practice Address - Street 1:AVE. PONCE DE LEON ESQ. AVE. UNIVERSIDAD
Practice Address - Street 2:PLAZA UNIVERSITARIA LOCAL #7
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-763-3992
Practice Address - Fax:787-771-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR264291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38375Medicare PIN