MEDICARE: GIACRIMAR CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	443	PR

General Provider Information

NPI Number	:	1407823800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIACRIMAR CORP

Provider Business Mailing Address
First Line	:	PO BOX 1554
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00613-1554
Country	:	US
Telephone Number	:	787-878-4670
Fax Number	:	787-816-6948

Provider Business Practice Location Address
First Line	:	208 AVE JOSE DE DIEGO
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00612-4585
Country	:	US
Telephone Number	:	787-878-4670
Fax Number	:	787-816-6948

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUAN CARLOS GONZALEZ
Credential	:
Telephone Number	:	787-878-4670

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/16/2008

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