Provider Demographics
NPI:1770642332
Name:EMPRESAS VICMAR INC
Entity Type:Organization
Organization Name:EMPRESAS VICMAR INC
Other - Org Name:LABORATORIO CLINICO ROYER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARACELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDA
Authorized Official - Phone:787-887-7857
Mailing Address - Street 1:PO BOX 195323
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5323
Mailing Address - Country:US
Mailing Address - Phone:787-887-7857
Mailing Address - Fax:787-887-7857
Practice Address - Street 1:AA5 CALLE C
Practice Address - Street 2:URB ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3474
Practice Address - Country:US
Practice Address - Phone:787-887-7857
Practice Address - Fax:787-887-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030886Medicare UPIN
PR0030886Medicare PIN