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General NPI Number Information
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NPI Number | 1134132392
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO LUIS M RIVERA
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | CALLE LUIS M RIVERA NO 21
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-883-5620
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Fax | 787-883-1442
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Provider Business Mailing Address
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Address Line | PO BOX 3768
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City | BAYAMON
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State | PR
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Zip | 00958
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Country | US
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Telephone | 787-883-5620
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Fax | 787-883-1442
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Authorized Official
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Title or Position | DIRECTOR
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Name | PROF. IVONNE ENID RIVERA ROMERO
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Credential |
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Telephone | 787-883-5620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 231
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License Number State | PR
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