Provider Demographics
NPI:1891179396
Name:MB CLINICAL LABORATORIES CORP
Entity Type:Organization
Organization Name:MB CLINICAL LABORATORIES CORP
Other - Org Name:LABORATORIO CLINICO VILLA ANA 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-734-8126
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0476
Mailing Address - Country:US
Mailing Address - Phone:787-475-8731
Mailing Address - Fax:
Practice Address - Street 1:148 CALLE CASUL
Practice Address - Street 2:URB VALENCIA #1
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-0476
Practice Address - Country:US
Practice Address - Phone:787-734-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MB CLINICAL LABORATORIES CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory