Provider Demographics
NPI:1225240013
Name:DOMENECH PATHOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:DOMENECH PATHOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAESTRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-758-7836
Mailing Address - Street 1:PO BOX 19-2369
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2369
Mailing Address - Country:US
Mailing Address - Phone:787-758-7836
Mailing Address - Fax:787-756-5393
Practice Address - Street 1:255 DOMENECH AVE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-758-7836
Practice Address - Fax:787-756-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR641B291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38118Medicare ID - Type UnspecifiedPROVIDER NUMBER