Organization
CLEVELAND SKIN PATHOLOGY LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DINA VALLADARES (DIRECTOR OF CREDENTIALING & PE)
(561) 514-5822
Entity
Organization
Contact information
Practice address
3737 PARK EAST DRIVE, SUITE #202, BEACHWOOD, OH 44122
(216) 464-7770
(216) 464-7531
Mailing address
11025 RCA CENTER DRIVE, SUITE 300, PALM BEACH GARDENS, FL 33410
(561) 514-5822
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
CLIA 36D0656050
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0252560
—
OH
01
—
36D0656050
CLIA
OH
Enumeration date
01/11/2006
Last updated
09/21/2017
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