Provider Demographics
NPI:1871633164
Name:MARIBEL DIAZ RUIZ LABORATORY SERVICES INC.
Entity Type:Organization
Organization Name:MARIBEL DIAZ RUIZ LABORATORY SERVICES INC.
Other - Org Name:LABORATORIO UNIVERSAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-758-3220
Mailing Address - Street 1:PO BOX 190849
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-0849
Mailing Address - Country:US
Mailing Address - Phone:787-758-3220
Mailing Address - Fax:787-758-3203
Practice Address - Street 1:513 AVE HOSTOS
Practice Address - Street 2:BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3235
Practice Address - Country:US
Practice Address - Phone:787-758-3220
Practice Address - Fax:787-758-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1085291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020284OtherPMC
PR100660OtherLA CRUZ AZUL DE PR
PRP981OtherIMC
PR31454OtherSSS, TRIPLE S
PR=========OtherCOSVI
PR0020284OtherPMC
PR31454OtherSSS, TRIPLE S
PR=========OtherMCS, MCS CLASSICARE
PR=========OtherMAPFRE
PR0031454Medicare ID - Type Unspecified