Healthcare Provider Details

I. General information

NPI: 1275682577
Provider Name (Legal Business Name): SAN PABLO PATHOLOGY GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CALLE SANTA CRUZ TORRE SAN PABLO SUITE 403-404
BAYAMON PR
00961-7031
US

IV. Provider business mailing address

PO BOX 1876
BAYAMON PR
00960-1876
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-9481
  • Fax:
Mailing address:
  • Phone: 787-787-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number517-B
License Number StatePR

VIII. Authorized Official

Name: JUAN SERRANO
Title or Position: DIRECTOR
Credential: M.D.
Phone: 787-787-9481