MEDICARE: LAB. LORIMAR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1194319939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAB. LORIMAR LLC

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-0388
Country	:	US
Telephone Number	:	787-385-7748
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 CALLE PEDRO SANTOS
Second Line	:
City	:	MOCA
State	:	PR
Zip	:	00676-4015
Country	:	US
Telephone Number	:	787-877-1236
Fax Number	:	787-877-1560

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JORGE L MENDEZ COLON
Credential	:	MD
Telephone Number	:	787-877-7700

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	03/09/2021

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