Provider Demographics
NPI:1821101403
Name:MONTEMAR CLINICAL LABS., INC.
Entity Type:Organization
Organization Name:MONTEMAR CLINICAL LABS., INC.
Other - Org Name:LABORATORIO CLINICO MONTEMAR
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-846-0303
Mailing Address - Street 1:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2406
Mailing Address - Country:US
Mailing Address - Phone:787-598-0889
Mailing Address - Fax:
Practice Address - Street 1:CARR 140 KM 63.4
Practice Address - Street 2:BO. MAGUEYES
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-846-0303
Practice Address - Fax:787-846-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1099291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031509Medicare PIN