1932438140 NPI number — MEMORIAL PATHOLOGY MEDICAL GROUP INC

Table of content: (NPI 1932438140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932438140 NPI number — MEMORIAL PATHOLOGY MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL PATHOLOGY MEDICAL GROUP INC
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:
1932438140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10076
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN NUYS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91410-0076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-578-8300
Provider Business Mailing Address Fax Number:
805-578-3911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14900 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MIRADA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90638-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-944-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
POWER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-907-1742

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  05D0897627 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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