MEDICARE: METRO PAVIA HEALTHCARE CENTERS 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	1214	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40D2001687	OTHER	PR	CLIA ID

General Provider Information

NPI Number	:	1912256090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO PAVIA HEALTHCARE CENTERS INC

Provider Business Mailing Address
First Line	:	PO BOX 9976
Second Line	:	COTTO STATION
City	:	ARECIBO
State	:	PR
Zip	:	00613-9976
Country	:	US
Telephone Number	:	787-651-2855
Fax Number	:	787-651-2866

Provider Business Practice Location Address
First Line	:	CALLE MARINA NUM 38
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0000
Country	:	US
Telephone Number	:	787-651-2855
Fax Number	:	787-651-2866

Authorized Official
Title or Position	:	HOSP ADMINISTRATOR
Name	:	MRS. MARIA L LOPEZ
Credential	:
Telephone Number	:	787-651-2855

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	01/30/2013

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Directions to “METRO PAVIA HEALTHCARE CENTERS INC ” Practice Location

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