Provider Demographics
NPI:1366526766
Name:LABORATORIO CLINICO MANATI
Entity type:Organization
Organization Name:LABORATORIO CLINICO MANATI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:I
Authorized Official - Credentials:BIO
Authorized Official - Phone:787-884-5886
Mailing Address - Street 1:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1855
Mailing Address - Country:US
Mailing Address - Phone:787-884-5886
Mailing Address - Fax:787-884-5886
Practice Address - Street 1:CALLE MARGINAL B6
Practice Address - Street 2:URB SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-5886
Practice Address - Fax:787-884-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR350291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory