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General NPI Number Information
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NPI Number | 1740823681
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Entity Type | Organization
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Legal Business Name | MENDEZ LABORATORY CLINIC INC
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | PLAZA ANIDEM LOCAL 4 CARR 447 KM 3.8 AIBONITO GUERRERO
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685
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Country | US
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Telephone | 787-280-8571
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 11465
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-9770
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Country | US
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Telephone | 787-896-5738
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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. CRISTOBAL IVAN MENDEZ RUIZ
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Credential | MD
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Telephone | 787-896-5738
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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 |
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License Number State |
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