Lab Clinico Y Bacteriologico Ebenezer

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

1003 Issued in PR

Legal business name

LAB CLINICO Y BACTERIOLOGICO EBENEZER

Doing business as

Maria Elena Nieves Muniz

Practice address

Road 2 KM 118 HM4
Bo. Ceiba Baja
Aguadilla, PR 00603-0000

Phone

(787) 882-1785

NPI assigned

Jan 14, 2008

Reactivated

Jun 24, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Maria Elena Nieves, M.T.

Title

Owner

Phone

(787) 882-1785

Specialties & licenses 1

Addresses

Other names 1

• MARIA ELENA NIEVES MUNIZ Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1275719874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3538",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "006053538",
            "telephone_number": "787-882-1785",
            "fax_number": "787-882-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROAD 2 KM 118 HM4",
            "address_2": "BO. CEIBA BAJA",
            "city": "AGUADILLA",
            "state": "PR",
            "postal_code": "006030000",
            "telephone_number": "787-882-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAB CLINICO Y BACTERIOLOGICO EBENEZER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "deactivation_date": "2008-07-22",
        "reactivation_date": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "NIEVES",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "ELENA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "787-882-1785",
        "authorized_official_credential": "M.T."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIA ELENA NIEVES MUNIZ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Aguadilla, PR
• Providers in Aguadilla, PR by specialty
• Clinical Medical Laboratory in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.