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General NPI Number Information
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NPI Number | 1932217536
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Entity Type | Organization
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Legal Business Name | TRESRIOS PATHOLOGY PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 W MAPLE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-5630
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Country | US
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Telephone | 505-327-2930
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Fax | 505-599-6290
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | FARMINGTON
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State | NM
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Zip | 87499-0407
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Country | US
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Telephone | 505-327-2930
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Fax | 505-599-6290
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. SCOTT OTTESON
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Credential | MD
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Telephone | 505-327-2930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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