Healthcare Provider Details

I. General information

NPI: 1336461128
Provider Name (Legal Business Name): ATLANTIC PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE JOSE CANDELAS MANATI MEDICAL PLAZA STE. 101
MANATI PR
00674-5507
US

IV. Provider business mailing address

400 CALLE KALAF PMB #59
SAN JUAN PR
00918-1314
US

V. Phone/Fax

Practice location:
  • Phone: 787-221-0171
  • Fax: 866-542-3629
Mailing address:
  • Phone: 787-221-0171
  • Fax: 866-542-3629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1209B
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JAVIER JESUS RORDRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-221-0171