Provider Demographics
NPI:1871580605
Name:UNIVERSITY PATHOLOGISTS, INC.
Entity type:Organization
Organization Name:UNIVERSITY PATHOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARCIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-726-5484
Mailing Address - Street 1:COND MADRID 1760 LOIZA STREET
Mailing Address - Street 2:SUITE #204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1801
Mailing Address - Country:US
Mailing Address - Phone:787-726-5486
Mailing Address - Fax:787-268-4417
Practice Address - Street 1:COND MADRID 1760 LOIZA STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1801
Practice Address - Country:US
Practice Address - Phone:787-726-5486
Practice Address - Fax:787-268-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR121291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR067852OtherCRUZ AZUL PROVIDER #
PR800078OtherMMM PROVIDER NUMBER
PR81063OtherTRIPLE-S, INC. PROVIDER #
PR9140009OtherHUMANA PROVIDER NUMBER
PR9140009OtherHUMANA PROVIDER NUMBER
PR9140009OtherHUMANA PROVIDER NUMBER