Healthcare Provider Details

I. General information

NPI: 1134119233
Provider Name (Legal Business Name): SOUTHERN PATHOLOGY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 DAIGUE INDUSTRIAL SABANETIS
PONCE PR
00715
US

IV. Provider business mailing address

PO BOX 10729
PONCE PR
00732-0729
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-8640
  • Fax: 787-043-3464
Mailing address:
  • Phone: 787-841-0042
  • Fax: 787-843-3464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNA VAQUER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 787-841-8645