1871580605 NPI number — UNIVERSITY PATHOLOGISTS, INC.

Table of content: (NPI 1871580605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871580605 NPI number — UNIVERSITY PATHOLOGISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PATHOLOGISTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871580605
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND MADRID 1760 LOIZA STREET
Provider Second Line Business Mailing Address:
SUITE #204
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00911-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-726-5486
Provider Business Mailing Address Fax Number:
787-268-4417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND MADRID 1760 LOIZA STREET
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00911-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-726-5486
Provider Business Practice Location Address Fax Number:
787-268-4417
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARCIAL
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-726-5484

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  121 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 067852 . This is a "CRUZ AZUL PROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 800078 . This is a "MMM PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 81063 . This is a "TRIPLE-S, INC. PROVIDER #" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 9140009 . This is a "HUMANA PROVIDER NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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