=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083923106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LABORATORIO CLINICO JOMYR, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2010
-----------------------------------------------------
Last Update Date | 05/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR. 187 INT. 186 MEDIANIA BAJA
-----------------------------------------------------
City | LOIZA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-957-5597
-----------------------------------------------------
Fax | 787-957-1577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 CARR. 693 PMB 212
-----------------------------------------------------
City | DORADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-777-0773
-----------------------------------------------------
Fax | 787-957-1577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS MYRNALI RIVERA MELENDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-340-7717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------