Provider Demographics
NPI:1124234422
Name:NORTHWESTERN MEDICAL LAB INC
Entity type:Organization
Organization Name:NORTHWESTERN MEDICAL LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-891-1481
Mailing Address - Street 1:PO BOX 250451
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0451
Mailing Address - Country:US
Mailing Address - Phone:787-891-1481
Mailing Address - Fax:787-891-1481
Practice Address - Street 1:24 AVE SEVERIANO CUEVAS STE 101
Practice Address - Street 2:AGUADILLA MEDICAL PLAZA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5762
Practice Address - Country:US
Practice Address - Phone:787-891-1481
Practice Address - Fax:787-891-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR309291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038277Medicare PIN