Provider Demographics
NPI:1922093020
Name:LABORATORIO CLINICO AMYR INC
Entity Type:Organization
Organization Name:LABORATORIO CLINICO AMYR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELBA
Authorized Official - Middle Name:N
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-763-2450
Mailing Address - Street 1:524 CALLE JUAN J JIMENEZ
Mailing Address - Street 2:PARQUE CENTRAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2605
Mailing Address - Country:US
Mailing Address - Phone:787-763-2450
Mailing Address - Fax:787-763-2638
Practice Address - Street 1:524 CALLE JUAN J JIMENEZ
Practice Address - Street 2:PARQUE CENTRAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2605
Practice Address - Country:US
Practice Address - Phone:787-763-2450
Practice Address - Fax:787-763-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR357291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038105Medicare ID - Type Unspecified