Dagmar Jomarie Correa, MS, MT

Individual provider Active NPI Clinical Medical Laboratory · Guayanilla, PR

NPI 1184148702 · NPPES record last updated Aug 6, 2020

Key facts

NPI
1184148702
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Medical Laboratory 291U00000X
License
12 (PR)
Practice address
Carr 132 KM 4.5
Barrio Macana
Guayanilla, PR 00656
Phone
(787) 630-9149
NPI assigned
Jul 26, 2017
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science, Medical Technician

State licenses

LicenseStateTypeSpecialty
12PRMDClinical Medical Laboratory

Practice roles

OrganizationSpecialtyStatusNew patients
Laboratorio Ebenezer LLC Clinical Medical Laboratory Current
since Aug 9, 2020
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 12 PR Yes

Addresses

Primary practice location

Carr 132 KM 4.5
Barrio Macana
Guayanilla, PR 00656

Mailing address

HC 1 Box 6131
Guayanilla, PR 00656-9444
Phone (787) 630-9149

Other practice location 1

31 Calle Mayor
Ponce, PR 00730-3726
Phone (787) 630-9149

Other providers in Guayanilla, PR

All providers in Guayanilla, PR · Clinical Medical Laboratory in Puerto Rico

Sources for this page

Verify at the official NPI Registry.