Provider Demographics
NPI:1144367509
Name:MB CLINICAL LABORATORIES CORP.
Entity type:Organization
Organization Name:MB CLINICAL LABORATORIES CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-734-8126
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-0476
Mailing Address - Country:US
Mailing Address - Phone:787-734-8126
Mailing Address - Fax:787-734-1927
Practice Address - Street 1:30 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3208
Practice Address - Country:US
Practice Address - Phone:787-732-5183
Practice Address - Fax:787-732-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR557291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR06713OtherPROSSAM
PR31080OtherSSS OPTIMO
PR050869OtherCRUZ AZUL
PR20209OtherPREFERRED MEDI
PR0013OtherFIRST MEDICAL
PR400258OtherPREFERRED HEALTH
PRLA0106OtherPALIC
PR31080OtherSSS
PR6070007OtherHUMANA HEALTH PLANS
PR800144OtherMMM
PR0030331Medicare PIN