MEDICARE: LABORATORIO CLINICO METABOLICO CORP.

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	291U00000X	Clinical Medical Laboratory	061	PR

General Provider Information

NPI Number	:	1750396347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORIO CLINICO METABOLICO CORP.

Provider Business Mailing Address
First Line	:	757 AVE HIPODROMO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2510
Country	:	US
Telephone Number	:	787-723-2807
Fax Number	:	787-723-2807

Provider Business Practice Location Address
First Line	:	1507 CALLE PROF AUGUSTO RODRIGUEZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-2214
Country	:	US
Telephone Number	:	787-723-2807
Fax Number	:	787-723-2807

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN B RIVERA
Credential	:
Telephone Number	:	787-723-2807

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	02/20/2025

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