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General NPI Number Information
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NPI Number | 1891229092
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Entity Type | Organization
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Legal Business Name | LABORATORIO CLINICO TRIXYMAR, PLAZA DEL MAR
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | CARR PR3 KM 85.6 BO BUENA VISTA EDIFICIO PLAZ DEL MAR LOCAL 12
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-656-8673
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | MAUNABO
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State | PR
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Zip | 00707-0097
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Country | US
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Telephone | 787-861-1111
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Fax |
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Authorized Official
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Title or Position | ADMINISTRADOR
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Name | MR. LUIS DIAZ-VEGA
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Credential |
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Telephone | 787-861-1111
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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 | 1283
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License Number State | PR
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