Provider Demographics
NPI:1427086917
Name:MARN PROSTHETIC LABORATORY MEDICAL CENTER INC
Entity type:Organization
Organization Name:MARN PROSTHETIC LABORATORY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-769-6849
Mailing Address - Street 1:PO BOX 29431
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0431
Mailing Address - Country:US
Mailing Address - Phone:787-769-6849
Mailing Address - Fax:787-769-6849
Practice Address - Street 1:AVE ITURREGUI OE 12
Practice Address - Street 2:4TA EXT COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-769-6849
Practice Address - Fax:787-769-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCF001018335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR55238OtherTRIPLE S
PR50393OtherPREFERRED MEDICARE CHOICE
PR=========OtherAMERICAN HEALTH
PR=========OtherCOSVI
PR50393OtherPREFERRED MEDICARE CHOICE
PR=========OtherHUMANA
PR=========OtherHUMANA