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General NPI Number Information
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NPI Number | 1770925109
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Entity Type | Organization
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Legal Business Name | INTEGRATED PATHOLOGY PSC
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 220 PLAZA WESTERN AUTO STE 101 PMB 395
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-3607
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Country | US
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Telephone | 787-305-5200
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Fax | 787-761-4526
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Provider Business Mailing Address
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Address Line | 220 PLAZA WESTERN AUTO STE 101 PMB 395
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976-3607
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Country | US
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Telephone | 787-305-5200
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Fax | 787-761-4526
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR CARLO VARGAS
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Credential | M.D.
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Telephone | 787-412-4477
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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 | 1291
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License Number State | PR
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