Healthcare Provider Details

I. General information

NPI: 1366511610
Provider Name (Legal Business Name): EL PASO PATHOLOGY LABORATORY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE #409
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE #409
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-4819
  • Fax: 505-556-6709
Mailing address:
  • Phone: 505-521-4819
  • Fax: 505-556-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNM

VIII. Authorized Official

Name: RICHARD D FERNANDEZ
Title or Position: MEDCIAL DIRECTOR
Credential: MD
Phone: 505-521-4819