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NPI Code Detail

MEDICARE: MALLON-ALVAREZ PATHOLOGY GROUP P C

MEDICARE: MALLON-ALVAREZ PATHOLOGY GROUP P C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical LaboratoryAZ

General Provider Information

NPI Number : 1679685952
Entity Type Code : Organization
Provider Name (Legal Business Name) : MALLON-ALVAREZ PATHOLOGY GROUP P C
Provider Business Mailing Address
First Line : PO BOX 4639
Second Line :
City : YUMA
State : AZ
Zip : 85366-4639
Country : US
Telephone Number : 928-336-7019
Fax Number : 928-336-7319
Provider Business Practice Location Address
First Line : 2400 S AVENUE A
Second Line :
City : YUMA
State : AZ
Zip : 85364-7170
Country : US
Telephone Number : 928-336-7019
Fax Number : 928-336-7319
Authorized Official
Title or Position : OWNER DIRECTOR
Name : VICTOR MANUEL ALVAREZ
Credential : MD
Telephone Number : 928-336-7019
Provider Enumeration Date : 08/31/2006
Last Update Date : 12/03/2010

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