Provider Demographics
NPI:1174837488
Name:SERVICIOS DE PATOLOGIA DE MANATI, PSC
Entity Type:Organization
Organization Name:SERVICIOS DE PATOLOGIA DE MANATI, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ-BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-403-0586
Mailing Address - Street 1:400 CALLE KALAF
Mailing Address - Street 2:PMB 59
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-221-0171
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE JOSE CANDELAS
Practice Address - Street 2:MANATI MEDICAL PLAZA SUITE 101
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5507
Practice Address - Country:US
Practice Address - Phone:787-221-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13598291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-16018Medicare UPIN