Provider Demographics
NPI:1629101696
Name:DAVID MENDEZ GONZALEZ
Entity Type:Organization
Organization Name:DAVID MENDEZ GONZALEZ
Other - Org Name:LABORATORIO CLINICO FLORES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIRMA
Authorized Official - Middle Name:I
Authorized Official - Last Name:FLORES CHEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-862-4230
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-0427
Mailing Address - Country:US
Mailing Address - Phone:787-862-4230
Mailing Address - Fax:787-862-4229
Practice Address - Street 1:CALLE COMERCIO 14
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0427
Practice Address - Country:US
Practice Address - Phone:787-862-4230
Practice Address - Fax:787-862-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLIC608291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
40D0670594OtherCLIA
0038297OtherPTAN