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General NPI Number Information
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NPI Number | 1295275865
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO MARTIN II, INC.
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 48 AVE MUNOZ RIVERA APT 2702
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-780-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 121 AVE BETANCES
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City | BAYAMON
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State | PR
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Zip | 00959
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Country | US
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Telephone | 787-780-8000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVELISSE MARTIN ORTIZ
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Credential | PH.D.
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Telephone | 787-780-8000
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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 | 659
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License Number State | PR
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