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General NPI Number Information
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NPI Number | 1871580605
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PATHOLOGISTS, INC.
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | COND MADRID 1760 LOIZA STREET SUITE 204
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City | SAN JUAN
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State | PR
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Zip | 00911-1801
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Country | US
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Telephone | 787-726-5486
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Fax | 787-268-4417
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Provider Business Mailing Address
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Address Line | COND MADRID 1760 LOIZA STREET SUITE #204
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City | SAN JUAN
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State | PR
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Zip | 00911-1801
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Country | US
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Telephone | 787-726-5486
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Fax | 787-268-4417
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANUEL A MARCIAL
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Credential | MD
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Telephone | 787-726-5484
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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 | 121
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License Number State | PR
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