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General NPI Number Information
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NPI Number | 1295856904
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Entity Type | Organization
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Legal Business Name | VISALMARY CLINICAL LABORATORY
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | CARR.638 KM 6.0 BO.MIRAFLORES
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City | ARECIBO
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State | PR
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Zip | 00616
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Country | US
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Telephone | 178-781-6225
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Fax | 787-816-2414
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Provider Business Mailing Address
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Address Line | PO BOX 30000 PMB 8001
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City | SABANA HOYOS
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State | PR
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Zip | 00688-8001
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Country | US
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Telephone | 178-781-6225
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Fax | 787-816-2414
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Authorized Official
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Title or Position | OWNER
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Name | MR. JESUS A DIAZ
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Credential | LCDO
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Telephone | 17878162251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 998
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License Number State | PR
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