Provider Demographics
NPI:1104251305
Name:CARMEN RIVERA MARCANO
Entity type:Organization
Organization Name:CARMEN RIVERA MARCANO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-599-0526
Mailing Address - Street 1:120 AVE. LAS SIERRAS
Mailing Address - Street 2:65
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-0000
Mailing Address - Country:US
Mailing Address - Phone:787-743-0166
Mailing Address - Fax:
Practice Address - Street 1:F-4 AVE DEGETAU BONNEVILLE TERRACE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-743-0166
Practice Address - Fax:787-715-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory