Provider Demographics
NPI:1407823800
Name:GIACRIMAR CORP
Entity Type:Organization
Organization Name:GIACRIMAR CORP
Other - Org Name:LABORATORIO CLINICO ROMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-4670
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-1554
Mailing Address - Country:US
Mailing Address - Phone:787-878-4670
Mailing Address - Fax:787-816-6948
Practice Address - Street 1:208 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4585
Practice Address - Country:US
Practice Address - Phone:787-878-4670
Practice Address - Fax:787-816-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR443291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031497Medicare PIN