1134132392 NPI number — LABORATORIO CLINICO LUIS M RIVERA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134132392 NPI number — LABORATORIO CLINICO LUIS M RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO LUIS M RIVERA
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:
1134132392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-883-5620
Provider Business Mailing Address Fax Number:
787-883-1442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE LUIS M RIVERA NO 21
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VEGA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-883-5620
Provider Business Practice Location Address Fax Number:
787-883-1442
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA ROMERO
Authorized Official First Name:
IVONNE
Authorized Official Middle Name:
ENID
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
787-883-5620

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  231 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com