Provider Demographics
NPI:1982931317
Name:CARLOS J FEBLES MENA
Entity Type:Organization
Organization Name:CARLOS J FEBLES MENA
Other - Org Name:LABORATORIO CLINICO GENESIS DEL DORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-796-2282
Mailing Address - Street 1:M10 CALLE ESTRELLA DEL MAR
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2147
Mailing Address - Country:US
Mailing Address - Phone:787-796-2282
Mailing Address - Fax:787-796-8086
Practice Address - Street 1:CARR# 693 KM 8.4
Practice Address - Street 2:MARGINAL COSTA DE ORO LOCAL A-6
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-796-2282
Practice Address - Fax:787-796-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR993291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031521Medicare PIN