Provider Demographics
NPI:1023364650
Name:CLINICAL PHYSICIANS PATHOLOGY LAB
Entity Type:Organization
Organization Name:CLINICAL PHYSICIANS PATHOLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAZARUS
Authorized Official - Middle Name:WILCOT
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-9800
Mailing Address - Street 1:2022 MURCHISON DR # 124
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3032
Mailing Address - Country:US
Mailing Address - Phone:915-532-9800
Mailing Address - Fax:915-532-9801
Practice Address - Street 1:1416 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-849-5141
Practice Address - Fax:915-849-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory