Provider Demographics
NPI:1689163594
Name:MIRELYS NIEVES DELGADO
Entity Type:Organization
Organization Name:MIRELYS NIEVES DELGADO
Other - Org Name:LABORATORIO CLINICO DOMINGUITO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-5324
Mailing Address - Street 1:PO BOX 9211
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9211
Mailing Address - Country:US
Mailing Address - Phone:787-878-5324
Mailing Address - Fax:787-878-5324
Practice Address - Street 1:CARRETERA 635 KM 2.4
Practice Address - Street 2:BO. DOMINGUITO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-5324
Practice Address - Fax:787-878-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR826291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory