1295856904 NPI number — VISALMARY CLINICAL LABORATORY

Table of content: (NPI 1295856904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295856904 NPI number — VISALMARY CLINICAL LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISALMARY CLINICAL LABORATORY
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:
1295856904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30000
Provider Second Line Business Mailing Address:
PMB 8001
Provider Business Mailing Address City Name:
SABANA HOYOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00688-8001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-781-6225
Provider Business Mailing Address Fax Number:
787-816-2414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR.638 KM 6.0
Provider Second Line Business Practice Location Address:
BO.MIRAFLORES
Provider Business Practice Location Address City Name:
ARECIBO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
178-781-6225
Provider Business Practice Location Address Fax Number:
787-816-2414
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
17878162251

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  998 , 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)





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