Provider Demographics
NPI:1659312825
Name:CENTRO DE PATOLOGIA AVANZADA DE PR CSP
Entity Type:Organization
Organization Name:CENTRO DE PATOLOGIA AVANZADA DE PR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-995-1818
Mailing Address - Street 1:PO BOX 363327
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3327
Mailing Address - Country:US
Mailing Address - Phone:787-995-1818
Mailing Address - Fax:787-995-1800
Practice Address - Street 1:I32 CALLE 8
Practice Address - Street 2:EXT HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5066
Practice Address - Country:US
Practice Address - Phone:787-995-1818
Practice Address - Fax:787-995-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1052207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085539Medicare PIN