Provider Demographics
NPI:1558460659
Name:DIAGNOSTIC CYTOPATHOLOGY LAB
Entity Type:Organization
Organization Name:DIAGNOSTIC CYTOPATHOLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTAELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-448-7213
Mailing Address - Street 1:PO BOX 140878
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-0878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2307 S DOUGLAS RD STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3057
Practice Address - Country:US
Practice Address - Phone:305-448-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL8378Medicare ID - Type Unspecified