Healthcare Provider Details

I. General information

NPI: 1740246545
Provider Name (Legal Business Name): PUERTO RICO PATHOLOGY ASSOCIATES P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
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

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

V. Phone/Fax

Practice location:
  • Phone: 787-726-5486
  • Fax: 787-268-4417
Mailing address:
  • Phone: 787-726-5486
  • Fax: 787-268-4417

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 TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number7716
License Number StatePR

VIII. Authorized Official

Name: DR. ELBA TORRES-MATUNDAN
Title or Position: PRESIDENT
Credential: MD
Phone: 787-718-5115