Basic Information
| Provider Information | |||||||||
| NPI: | 1740246545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PUERTO RICO PATHOLOGY ASSOCIATES P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 198 CALLE TRINIDAD STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009172900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877265486 | ||||||||
| FaxNumber: | 7872684417 | ||||||||
| Practice Location | |||||||||
| Address1: | 198 CALLE TRINIDAD STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009172900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877265486 | ||||||||
| FaxNumber: | 7872684417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | TORRES-MATUNDAN | ||||||||
| AuthorizedOfficialFirstName: | ELBA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7877185115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 7716 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.