Provider Demographics
NPI:1750396347
Name:LABORATORIO CLINICO METABOLICO CORP.
Entity type:Organization
Organization Name:LABORATORIO CLINICO METABOLICO CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-723-2807
Mailing Address - Street 1:757 AVE HIPODROMO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2510
Mailing Address - Country:US
Mailing Address - Phone:787-723-2807
Mailing Address - Fax:787-723-2807
Practice Address - Street 1:1507 CALLE PROF AUGUSTO RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2214
Practice Address - Country:US
Practice Address - Phone:787-723-2807
Practice Address - Fax:787-723-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR061291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038097Medicare ID - Type Unspecified