Provider Demographics
NPI:1598735565
Name:LABORATORIO VASCULAR CLINICO PONCE INC
Entity Type:Organization
Organization Name:LABORATORIO VASCULAR CLINICO PONCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-0670
Mailing Address - Street 1:PO BOX 7123
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7123
Mailing Address - Country:US
Mailing Address - Phone:787-840-0670
Mailing Address - Fax:787-841-6442
Practice Address - Street 1:2213 PONCE BY PASS
Practice Address - Street 2:HOSPITAL DAMAS PRIMER PISO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1318
Practice Address - Country:US
Practice Address - Phone:787-840-0670
Practice Address - Fax:787-841-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
29197Medicare ID - Type Unspecified