Provider Demographics
NPI:1639285091
Name:MB CLINICAL LABORATORIES CORP.
Entity Type:Organization
Organization Name:MB CLINICAL LABORATORIES CORP.
Other - Org Name:LABORATORIO CLINICO VILLA ANA AGUAS BUENAS LLL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-734-8126
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0476
Mailing Address - Country:US
Mailing Address - Phone:787-734-8126
Mailing Address - Fax:787-734-1927
Practice Address - Street 1:CARR 174 KM 12.1
Practice Address - Street 2:BARRIO MULAS
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-732-0210
Practice Address - Fax:787-732-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR888291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLA-0429OtherPALIC PROVIDER
PR800172OtherMMM
PR051847OtherCRUZ AZUL
PR30110OtherTRIPLE S INC
PR5185OtherINTERNATIONAL MEDICAL
PR=========OtherMAPHRE
PR=========OtherCOSVI
PR31130Medicare ID - Type Unspecified
PR2690-3OtherASOCIACION DE MAESTROS
PR400528OtherU.T.I
PR7030007OtherHUMANA HEALTH PLANS
PR=========OtherMCS
PR=========OtherCIGNA HEALTH CARE
PR2039OtherAPS HEALTHCARE