Provider Demographics
NPI:1578560314
Name:LABORATORIO VASCULAR CLINICO INC
Entity Type:Organization
Organization Name:LABORATORIO VASCULAR CLINICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACARON SOUFFRONT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-758-7500
Mailing Address - Street 1:PO BOX 194478
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4814
Mailing Address - Country:US
Mailing Address - Phone:787-758-7500
Mailing Address - Fax:787-758-0975
Practice Address - Street 1:716 PONCE DE LEON AVE.
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-4510
Practice Address - Country:US
Practice Address - Phone:787-758-7500
Practice Address - Fax:787-758-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28100Medicare PIN