Provider Demographics
NPI:1942461355
Name:MAS RIVERA, LILLIAN V (MT)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:V
Last Name:MAS RIVERA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:LABORATORIO
Other - Middle Name:EXTENSION
Other - Last Name:EL COMANDANTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:675 CALLE PRINCESA
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 AVE SAN MARCOS
Practice Address - Street 2:EXT,EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3616
Practice Address - Country:US
Practice Address - Phone:787-757-9588
Practice Address - Fax:787-757-9588
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR699291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30577Medicare PIN