Provider Demographics
NPI:1588785398
Name:LABORATORIO CLINICO MANUED
Entity type:Organization
Organization Name:LABORATORIO CLINICO MANUED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TORRELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-852-0243
Mailing Address - Street 1:CALLE DOLORES CABRERA ALONSO 56-ESTE
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4265
Mailing Address - Country:US
Mailing Address - Phone:787-852-0243
Mailing Address - Fax:787-850-6785
Practice Address - Street 1:DOLORES CABRERA 56-E
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4265
Practice Address - Country:US
Practice Address - Phone:787-852-0243
Practice Address - Fax:787-850-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038320Medicare ID - Type Unspecified