Provider Demographics
NPI:1760563563
Name:LABORATORIO CLINICO OBYMAR
Entity Type:Organization
Organization Name:LABORATORIO CLINICO OBYMAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGY PORPIETARIA
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGY
Authorized Official - Phone:787-818-1325
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0047
Mailing Address - Country:US
Mailing Address - Phone:787-818-1325
Mailing Address - Fax:787-818-1325
Practice Address - Street 1:CARRETERRA 420 KM 0.4 BARRIO VOLADORAS
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-1325
Practice Address - Fax:787-818-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
6606Z8944OtherCIGNA HEALTHCARE
6606Z8944OtherCRUZ AZUL
6606Z8944OtherMCS
6606Z8944OtherBELLA VISTA
6606Z8944OtherTRICARE
6606Z8944OtherAETNA
6606Z8944OtherMAMPRE
6606Z8944OtherHUMANA HEALTH
6606Z8944OtherAMERICAN HEALTH
6606Z8944OtherCOSVI
6606Z8944OtherMCS REFORMA
6606Z8944OtherFIRST PLUS
6606Z8944OtherHUMANA INSURANCE
6606Z8944OtherINTERNATIONAL MEDICALCAID
6606Z8944OtherPAN AMERICAN
6606Z8944OtherOPTION HEALTHCARE