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General NPI Number Information
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NPI Number | 1700255841
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Entity Type | Organization
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Legal Business Name | FIRST COAST PATHOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 9421 WAYPOINT PLACE
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City | JACKSONVILLE
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State | FL
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Zip | 32257
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Country | US
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Telephone | 904-302-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 9102 DUCALE WAY APT 204
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-8164
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | VIRENDRA DESAI
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Credential | MD
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Telephone | 904-302-3553
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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 | ME 93419
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License Number State | FL
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