Provider Demographics
NPI:1295856904
Name:VISALMARY CLINICAL LABORATORY
Entity Type:Organization
Organization Name:VISALMARY CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:1787-816-2251
Mailing Address - Street 1:PO BOX 30000
Mailing Address - Street 2:PMB 8001
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688-8001
Mailing Address - Country:US
Mailing Address - Phone:178-781-6225
Mailing Address - Fax:787-816-2414
Practice Address - Street 1:CARR.638 KM 6.0
Practice Address - Street 2:BO.MIRAFLORES
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00616
Practice Address - Country:US
Practice Address - Phone:178-781-6225
Practice Address - Fax:787-816-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR998291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30133Medicare ID - Type UnspecifiedCLINICAL LABORATORY