Provider Demographics
NPI:1346513678
Name:DERMOPATH LABORATORIES, L.L.C.
Entity Type:Organization
Organization Name:DERMOPATH LABORATORIES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-621-5094
Mailing Address - Street 1:1501 BROADWAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-4906
Mailing Address - Country:US
Mailing Address - Phone:409-621-5094
Mailing Address - Fax:409-621-5132
Practice Address - Street 1:1501 BROADWAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4906
Practice Address - Country:US
Practice Address - Phone:409-621-5094
Practice Address - Fax:409-621-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0950289291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory