MEDICARE: MARINA & SONS INC.

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	:	1790119642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA & SONS INC.

Provider Business Mailing Address
First Line	:	120 AVE LAS SIERRAS
Second Line	:	65
City	:	SAN JUAN
State	:	PR
Zip	:	00926-0000
Country	:	US
Telephone Number	:	787-599-0526
Fax Number	:	787-715-0170

Provider Business Practice Location Address
First Line	:	126 AVE DE DIEGO
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3036
Country	:	US
Telephone Number	:	787-599-0526
Fax Number	:	787-715-0170

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MANUEL ALBERTO GUEVARA
Credential	:
Telephone Number	:	787-599-0526

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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