Healthcare Provider Details

I. General information

NPI: 1275521098
Provider Name (Legal Business Name): UNIVERSITY PATHOLOGY ASSOCIATES, PCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL AUXILIO MUTUO 3ER PISO EDIFICIO VIEJO
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 21380
SAN JUAN PR
00928
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-5336
  • Fax: 787-753-5337
Mailing address:
  • Phone: 787-250-0251
  • Fax: 787-250-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number90B
License Number StatePR

VIII. Authorized Official

Name: MR. WILFRED REYES
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-250-0251