Provider Demographics
NPI:1558550061
Name:SUNCOAST PATHOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:SUNCOAST PATHOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-795-1321
Mailing Address - Street 1:3030 VENTURE LN
Mailing Address - Street 2:STE 108
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8172
Mailing Address - Country:US
Mailing Address - Phone:321-253-5197
Mailing Address - Fax:321-253-5199
Practice Address - Street 1:3030 VENTURE LN
Practice Address - Street 2:STE 108
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8172
Practice Address - Country:US
Practice Address - Phone:321-253-5197
Practice Address - Fax:321-253-5199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-21
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800021486207ZP0105X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty