Provider Demographics
NPI:1821777053
Name:KIKITA CLINICAL LABORATORY, LLC
Entity Type:Organization
Organization Name:KIKITA CLINICAL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLIGIST
Authorized Official - Phone:787-515-4307
Mailing Address - Street 1:HC-46 BOX 6040
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-515-4307
Mailing Address - Fax:
Practice Address - Street 1:AVE. PEDRO ALBIZU CAMPOS
Practice Address - Street 2:#155 BO. MAMEYAL
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-515-4307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory