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General NPI Number Information
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NPI Number | 1225240013
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Entity Type | Organization
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Legal Business Name | DOMENECH PATHOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 255 DOMENECH AVE
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City | SAN JUAN
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-758-7836
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Fax | 787-756-5393
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Provider Business Mailing Address
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Address Line | PO BOX 19-2369
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City | SAN JUAN
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State | PR
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Zip | 00919-2369
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Country | US
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Telephone | 787-758-7836
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Fax | 787-756-5393
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARBARA E MAESTRE
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Credential | MD
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Telephone | 787-758-7836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 641B
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License Number State | PR
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