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General NPI Number Information
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NPI Number | 1831279587
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Entity Type | Organization
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Legal Business Name | OUTREACH PATHOLOGY PLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7127
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Country | US
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Telephone | 928-343-7911
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Fax | 928-343-9547
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Provider Business Mailing Address
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Address Line | PO BOX 5701
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City | YUMA
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State | AZ
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Zip | 85366-5701
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Country | US
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Telephone | 928-343-7911
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Fax | 928-343-9547
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | VICTOR MANUEL ALVAREZ
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Credential | MD
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Telephone | 928-343-7911
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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 | AZ
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