1427166230 NPI number — LABORATORIO VASCULAR NO INVASIVO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427166230 NPI number — LABORATORIO VASCULAR NO INVASIVO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LABORATORIO VASCULAR NO INVASIVO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427166230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3049
Provider Second Line Business Mailing Address:
MARINA STATION
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00681-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-834-8030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MENDEZ VIGO 109 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYAGUEZ
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-834-8030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SURIS
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CIRUJANO
Authorized Official Telephone Number:
787-834-8030

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  30725 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30725 . This is a "MUNICIPAL PATENT" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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