Provider Demographics
NPI:1851365902
Name:LABORATORIO CLINICO MENDEZ
Entity Type:Organization
Organization Name:LABORATORIO CLINICO MENDEZ
Other - Org Name:LABORATORIO MENDEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER LABORATORIO CLINICO MENDEZ
Authorized Official - Prefix:
Authorized Official - First Name:HERNAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANCHE RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:787-877-8300
Mailing Address - Street 1:205 CALLE JUAN SAN ANTONIO
Mailing Address - Street 2:EDIFICIO BOZQUES OFICINA #3
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4144
Mailing Address - Country:US
Mailing Address - Phone:787-877-8300
Mailing Address - Fax:787-877-8300
Practice Address - Street 1:CALLE JUAN SAN ANTONIO #205
Practice Address - Street 2:EDIFICIO BOZQUES OFICINA #3
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-8300
Practice Address - Fax:787-877-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR560291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31310Medicare ID - Type Unspecified