Provider Demographics
NPI:1740823681
Name:MENDEZ LABORATORY CLINIC INC
Entity type:Organization
Organization Name:MENDEZ LABORATORY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:MENDEZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-896-5738
Mailing Address - Street 1:HC 1 BOX 11465
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9770
Mailing Address - Country:US
Mailing Address - Phone:787-896-5738
Mailing Address - Fax:
Practice Address - Street 1:PLAZA ANIDEM LOCAL 4
Practice Address - Street 2:CARR 447 KM 3.8 AIBONITO GUERRERO
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-8571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory