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General NPI Number Information
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NPI Number | 1578948600
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Entity Type | Organization
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Legal Business Name | MB CLINICAL LABORATORIES CORP
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 30 CALLE MUNOZ RIVERA
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City | AGUAS BUENAS
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State | PR
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Zip | 00703-3208
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Country | US
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Telephone | 787-732-5183
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Fax | 787-732-1222
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Provider Business Mailing Address
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Address Line | PO BOX 476
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City | JUNCOS
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State | PR
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Zip | 00777-0476
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Country | US
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Telephone | 787-734-8126
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Fax | 787-734-1927
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. MYRNA LIZ BELTRAN
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Credential | MT
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Telephone | 787-734-8126
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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 | 557
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License Number State | PR
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