Provider Demographics
NPI:1033462403
Name:PUERTO RICO DERMATOPATHOLOGY LABORATORY INC
Entity Type:Organization
Organization Name:PUERTO RICO DERMATOPATHOLOGY LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-751-6018
Mailing Address - Street 1:516B CALLE JUAN J JIMENEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2605
Mailing Address - Country:US
Mailing Address - Phone:787-751-6018
Mailing Address - Fax:787-751-6018
Practice Address - Street 1:516B CALLE JUAN J JIMENEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2605
Practice Address - Country:US
Practice Address - Phone:787-751-6018
Practice Address - Fax:787-751-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14181207ND0900X
PR3124207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty