1952325565 NPI number — UNIVERSITY PATHOLOGY ASSOCIATES, INC.

Table of content: (NPI 1952325565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952325565 NPI number — UNIVERSITY PATHOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY PATHOLOGY ASSOCIATES, 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:
1952325565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2011 ZONAL AVE
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90089-5364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-442-2582
Provider Business Mailing Address Fax Number:
323-442-2588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2011 ZONAL AVE,
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-0181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-2582
Provider Business Practice Location Address Fax Number:
323-442-2588
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CLIVE
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-442-1180

Provider Taxonomy Codes

  • Taxonomy code: 207ZB0001X , with the licence number:  05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZC0500X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZD0900X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZF0201X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZI0100X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZM0300X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZN0500X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0007X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0104X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0213X , with the licence number: 05D0928654 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05D0939440 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0928654 . This is a "CLIA ID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CH7107 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0101420 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0101421 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D1065390 . This is a "CLIA NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CG4848 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CQ2142 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D0058906 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LAB28654F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D0670053 . This is a "CLIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 807975000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: LAB39440F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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