Provider Demographics
NPI:1922131903
Name:DIAGNOSTIC CYTOPATHOLOGY LABORATORY INC
Entity Type:Organization
Organization Name:DIAGNOSTIC CYTOPATHOLOGY LABORATORY INC
Other - Org Name:FINE NEEDLE ASPIRATION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
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:305-448-7213
Mailing Address - Fax:305-448-9282
Practice Address - Street 1:135 SAN LORENZO AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1524
Practice Address - Country:US
Practice Address - Phone:305-448-7213
Practice Address - Fax:305-448-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44084207SM0001X, 207ZC0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 2085U0001X, 208D00000X, 246R00000X, 246RH0600X, 246RM2200X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Multi-Specialty
No246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistologyGroup - Multi-Specialty
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056941100Medicaid