Provider Demographics
NPI:1801031596
Name:ADRIAN N. VICENTY RIVERA
Entity Type:Organization
Organization Name:ADRIAN N. VICENTY RIVERA
Other - Org Name:LABORATORIO PLAYA PUERTO REAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR(OWNER)
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:VICENTY
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-851-4501
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-851-4501
Mailing Address - Fax:787-851-4501
Practice Address - Street 1:CALLE 12 NUMERO 38
Practice Address - Street 2:COMUNIDAD ELIZABETH BO. PUERTO REAL
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-851-4501
Practice Address - Fax:787-851-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1171291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory