Provider Demographics
NPI:1851464044
Name:WESTERN PATHOLOGY AND CITOLOGY LAB
Entity Type:Organization
Organization Name:WESTERN PATHOLOGY AND CITOLOGY LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST DIRECTOR OF LABORATORY
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:RIVERA BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-832-6900
Mailing Address - Street 1:URB VISTA VERDE
Mailing Address - Street 2:59 ZAFIRO
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-2516
Mailing Address - Country:US
Mailing Address - Phone:787-832-6900
Mailing Address - Fax:787-832-6902
Practice Address - Street 1:CALLE PERAL #14 ESQUINA DE DIEGO
Practice Address - Street 2:EDIFICIO LA PALMA 1G
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-6900
Practice Address - Fax:787-832-6902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR250B291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory