MEDICARE: MS. CARMEN CERMIRA RIVERA MARCANO BA NT ASCP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist	1095	PR
2	246RM2200X	Medical Laboratory Technician	1095	PR
3	291U00000X	Clinical Medical Laboratory	1095	PR

General Provider Information

NPI Number	:	1306831318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARMEN CERMIRA RIVERA MARCANO BA NT ASCP

Provider Business Mailing Address
First Line	:	MUNOZ RIVERA ST 5 SUR
Second Line	:	LABORATORIO LICER
City	:	SAN LORENZO
State	:	PR
Zip	:	00754
Country	:	US
Telephone Number	:	787-736-2951
Fax Number	:	787-715-0170

Provider Business Practice Location Address
First Line	:	MUNOZ RIVERA ST 5 SUR
Second Line	:
City	:	SAN LORENZO
State	:	PR
Zip	:	00754
Country	:	US
Telephone Number	:	787-548-5816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/14/2013

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