Provider Demographics
NPI:1891839627
Name:LILLIAN-V-MAS-RIVERA
Entity Type:Organization
Organization Name:LILLIAN-V-MAS-RIVERA
Other - Org Name:LAB-CLINICO-EXT-EL-COMANDANTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MAS RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-757-9588
Mailing Address - Street 1:237 SAN MARCOS
Mailing Address - Street 2:EXT EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3664
Mailing Address - Country:US
Mailing Address - Phone:787-757-9588
Mailing Address - Fax:787-757-9588
Practice Address - Street 1:237 SAN MARCOS
Practice Address - Street 2:EXT EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3664
Practice Address - Country:US
Practice Address - Phone:787-757-9588
Practice Address - Fax:787-757-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR699291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30577Medicare ID - Type Unspecified