1386340693 NPI number — MAYAGUEZ CLINICAL LAB, INC.

Table of content: (NPI 1386340693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386340693 NPI number — MAYAGUEZ CLINICAL LAB, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAYAGUEZ CLINICAL LAB, INC.
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:
6
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:
1386340693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PERAL 27
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
MAYAGUEZ, PR
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-832-4376
Provider Business Mailing Address Fax Number:
787-827-9300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BASORA 55
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-832-4376
Provider Business Practice Location Address Fax Number:
787-827-9300
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-832-4376

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)





Copyright © 2007-2025 www.npivalidator.com