Provider Demographics
NPI:1316481211
Name:LABORATORIO CLINIC OMARIS, INC
Entity type:Organization
Organization Name:LABORATORIO CLINIC OMARIS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-262-7071
Mailing Address - Street 1:262 CALLE MARGINAL EDIFICIO OMARYS SUITE 4
Mailing Address - Street 2:BO PUEBLO
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:787-262-7071
Mailing Address - Fax:787-262-7071
Practice Address - Street 1:PR 2 KM 86.2 CALLE MARGINAL
Practice Address - Street 2:BO PUEBLO
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-262-7071
Practice Address - Fax:787-262-7071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABORATORIO CLINIC OMARIS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR933291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR933OtherPR LICENSE