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General NPI Number Information
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NPI Number | 1316752447
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Entity Type | Organization
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Legal Business Name | MEDIPATH LLC
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 4665 PONCE DE LEON BLVD # 2B
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City | CORAL GABLES
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State | FL
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Zip | 33146-2101
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Country | US
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Telephone | 786-464-0749
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Fax | 786-953-5764
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Provider Business Mailing Address
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Address Line | 4665 PONCE DE LEON BLVD # 2B
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City | CORAL GABLES
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State | FL
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Zip | 33146-2101
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Country | US
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Telephone | 786-464-0749
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Fax | 786-953-5764
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GINA SALAZAR
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Credential |
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Telephone | 786-464-0749
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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 |
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License Number State |
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