1760563563 NPI number — LABORATORIO CLINICO OBYMAR

Table of content: (NPI 1760563563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760563563 NPI number — LABORATORIO CLINICO OBYMAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO OBYMAR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760563563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISABELA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00662-0047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-818-1325
Provider Business Mailing Address Fax Number:
787-818-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERRA 420 KM 0.4 BARRIO VOLADORAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-818-1325
Provider Business Practice Location Address Fax Number:
787-818-1325
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL TECHNOLOGY PORPIETARIA
Authorized Official Telephone Number:
787-818-1325

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6606Z8944 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "CRUZ AZUL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "MCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "BELLA VISTA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "MAMPRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "HUMANA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "COSVI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "MCS REFORMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "FIRST PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "HUMANA INSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "INTERNATIONAL MEDICALCAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "PAN AMERICAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6606Z8944 . This is a "OPTION HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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