=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205895844
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOCA PATHOLOGY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MEADOWS RD BOCA COMMUNITY HOSPITAL
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-955-4136
-----------------------------------------------------
Fax | 561-955-5268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 63069
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-229-4311
-----------------------------------------------------
Fax | 305-229-4388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MIGUEL A BRITO JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-955-4136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------