Provider Demographics
NPI: | 1942375746 |
---|---|
Name: | LABORATORIO CLINICO MARGIMAR INC |
Entity Type: | Organization |
Organization Name: | LABORATORIO CLINICO MARGIMAR INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ISIDRO |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MARTINEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-843-1984 |
Mailing Address - Street 1: | PO BOX 7052 |
Mailing Address - Street 2: | |
Mailing Address - City: | PONCE |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00732 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-840-6593 |
Mailing Address - Fax: | 787-840-6578 |
Practice Address - Street 1: | GLENVIEW GARDENS DEV S3 F11 |
Practice Address - Street 2: | |
Practice Address - City: | PONCE |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00733 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-840-6593 |
Practice Address - Fax: | 787-840-6578 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PR | 30047 | Medicare ID - Type Unspecified |