1659538932 NPI number — LABORATORIO CLINICO EL VIVI

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659538932 NPI number — LABORATORIO CLINICO EL VIVI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO CLINICO EL VIVI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659538932
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9975
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00613-9975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-879-5704
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 CALLE BETANCES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTUADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00641-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-894-2270
Provider Business Practice Location Address Fax Number:
787-894-2270
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NATAL
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
RIVERA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-879-5704

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  509 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 509 . This is a "LICENCIA DE SALUD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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