Provider Demographics
NPI:1689656746
Name:LABORATORIO CLINICO MARIE-E, INC.
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MARIE-E, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-269-1799
Mailing Address - Street 1:PO BOX 3310
Mailing Address - Street 2:BAYAMON GARDEN STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-3310
Mailing Address - Country:US
Mailing Address - Phone:787-269-1799
Mailing Address - Fax:787-787-3708
Practice Address - Street 1:CARR 862 KM 2-7
Practice Address - Street 2:HATO TEJAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-269-1799
Practice Address - Fax:787-787-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR923291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31286Medicare PIN