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Organization
VASCULAR DIAGNOSTIC LAB
Active
Organization
VASCULAR DIAGNOSTIC LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RITA POLSKY (ADMINISTRATOR)
(575) 635-7145
Entity
Organization
Contact information
Practice address
3850 FOOTHILLS RD., #3, LAS CRUCES, NM 88011-8268
(575) 522-5511
(575) 522-0825
Mailing address
P.O. BOX 6366, LAS CRUCES, NM 88006-6366
(575) 522-5511
(575) 522-0825
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00052597
—
NM
Enumeration date
04/12/2007
Last updated
12/31/2014
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