Healthcare Provider Details

I. General information

NPI: 1821770793
Provider Name (Legal Business Name): M DEL MAR LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO CENTRO CARR 110 K 19.6
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 1789
AGUADILLA PR
00605-1789
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-2154
  • Fax:
Mailing address:
  • Phone: 787-826-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KORAL DEL MAR HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 787-891-2154