Provider Demographics
NPI:1689011124
Name:METRO PAVIA HEALTHCARE CENTERS INC
Entity Type:Organization
Organization Name:METRO PAVIA HEALTHCARE CENTERS INC
Other - Org Name:LABORATORIO METROPAVIA CLINIC PONCE
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSP ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-651-2855
Mailing Address - Street 1:PO BOX 9976
Mailing Address - Street 2:COTTO STATION
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9976
Mailing Address - Country:US
Mailing Address - Phone:787-651-2855
Mailing Address - Fax:787-651-2866
Practice Address - Street 1:CALLE MARINA 38
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0000
Practice Address - Country:US
Practice Address - Phone:787-651-2855
Practice Address - Fax:787-651-2866
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO PAVIA HEALTHCARE CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1214291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48OtherSTATE LICENSE