Healthcare Provider Details

I. General information

NPI: 1669669214
Provider Name (Legal Business Name): CARMONA PATHOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 N WASHINGTON AVE
TITUSVILLE FL
32796-2163
US

IV. Provider business mailing address

3450 BUSCHWOOD PARK DR SUITE 150
TAMPA FL
33618-4465
US

V. Phone/Fax

Practice location:
  • Phone: 321-268-6111
  • Fax: 321-268-6149
Mailing address:
  • Phone: 813-935-8501
  • Fax: 813-935-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: PEDRO CARMONA
Title or Position: PRESIDENT
Credential: MD
Phone: 321-268-6111