Provider Demographics
NPI:1164891396
Name:LABORATORIO CLINICO TRIXYMAR
Entity Type:Organization
Organization Name:LABORATORIO CLINICO TRIXYMAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-861-1111
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0097
Mailing Address - Country:US
Mailing Address - Phone:787-861-1111
Mailing Address - Fax:787-861-4444
Practice Address - Street 1:CARR. 753 KM 2.1
Practice Address - Street 2:BO PITAHAYA
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-0000
Practice Address - Country:US
Practice Address - Phone:787-839-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIXYMAR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1332291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREL541AMedicare PIN