1891914529 NPI number — PATHOLOGY BUSINESS SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891914529 NPI number — PATHOLOGY BUSINESS SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY BUSINESS SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891914529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19951 MARINER AVE
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-225-3244
Provider Business Mailing Address Fax Number:
310-698-7054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19951 MARINER AVE
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90503-1672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-225-3244
Provider Business Practice Location Address Fax Number:
310-698-7054
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANNON
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
310-225-3270

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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