Healthcare Provider Details

I. General information

NPI: 1497019277
Provider Name (Legal Business Name): LORENA DI PASQUALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 CALLE TRINIDAD STE 102
SAN JUAN PR
00917-2900
US

IV. Provider business mailing address

UNIVERSITY DISTRICT HOSPITAL PUERTO RICO MEDICAL CENTER BO. MONACILLOS
SAN JUAN PR
00935-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-5486
  • Fax:
Mailing address:
  • Phone: 787-754-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number19864
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: