Provider Demographics
NPI:1750566592
Name:LABORATORIO CLINICO MANATI
Entity type:Organization
Organization Name:LABORATORIO CLINICO MANATI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYSONET
Authorized Official - Suffix:SR
Authorized Official - Credentials:LAB
Authorized Official - Phone:787-884-5886
Mailing Address - Street 1:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1855
Mailing Address - Country:US
Mailing Address - Phone:787-884-5886
Mailing Address - Fax:787-884-5886
Practice Address - Street 1:CALLE MARGINAL B-6
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-5886
Practice Address - Fax:787-884-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR350291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory