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General NPI Number Information
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NPI Number | 1417264011
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Entity Type | Organization
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Legal Business Name | ACCESS DERMPATH INC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 4805 NW 2ND AVE
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City | BOCA RATON
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State | FL
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Zip | 33431-4141
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Country | US
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Telephone | 352-536-9270
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Fax | 525-369-2793
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Provider Business Mailing Address
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Address Line | 3705 S HIGHWAY 27
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City | CLERMONT
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State | FL
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Zip | 34711-7950
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Country | US
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Telephone | 352-536-9270
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Fax | 352-536-9279
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | PATRICIA OWEN
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Credential |
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Telephone | 352-536-9270
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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 | 10D2009723
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License Number State | FL
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