Provider Demographics
NPI:1255367488
Name:LABORATORIO CLINICO DY-MATOS, INC.
Entity type:Organization
Organization Name:LABORATORIO CLINICO DY-MATOS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-786-4589
Mailing Address - Street 1:RR 7 BOX 17157
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8845
Mailing Address - Country:US
Mailing Address - Phone:787-786-4589
Mailing Address - Fax:787-798-0860
Practice Address - Street 1:C-25 MARGINAL
Practice Address - Street 2:EXTENSION FOREST HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-786-4589
Practice Address - Fax:787-798-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR431291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031488Medicare ID - Type UnspecifiedCLINICAL LABORATORY