Healthcare Provider Details

I. General information

NPI: 1033462403
Provider Name (Legal Business Name): PUERTO RICO DERMATOPATHOLOGY LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516B CALLE JUAN J JIMENEZ
SAN JUAN PR
00918-2605
US

IV. Provider business mailing address

516B CALLE JUAN J JIMENEZ
SAN JUAN PR
00918-2605
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-6018
  • Fax: 787-751-6018
Mailing address:
  • Phone: 787-751-6018
  • Fax: 787-751-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number14181
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number3124
License Number StatePR

VIII. Authorized Official

Name: DR. JORGE L. SANCHEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-751-6018