Provider Demographics
NPI:1891229092
Name:LABORATORIO CLINICO TRIXYMAR, PLAZA DEL MAR
Entity Type:Organization
Organization Name:LABORATORIO CLINICO TRIXYMAR, PLAZA DEL MAR
Other - Org Name:
Other - Org Type:
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:
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:
Practice Address - Street 1:CARR PR3 KM 85.6 BO BUENA VISTA
Practice Address - Street 2:EDIFICIO PLAZ DEL MAR LOCAL 12
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-656-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIXYMAR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1283291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory