Provider Demographics
NPI:1437310653
Name:TRIXYMAR INC
Entity Type:Organization
Organization Name:TRIXYMAR INC
Other - Org Name:LABORATORIO CLINICO Y BACTERIOLOGICO TRIXYMAR
Other - Org Type:Doing Business As
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:SR
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 1:17 CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-2147
Practice Address - Country:US
Practice Address - Phone:787-861-1111
Practice Address - Fax:787-861-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1230291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREL541AOtherMEDICARE ID