1194953810 NPI number — GLOBAL DERMATOPATHOLOGY SERVICES, PLC

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 1194953810 NPI number — GLOBAL DERMATOPATHOLOGY SERVICES, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOBAL DERMATOPATHOLOGY SERVICES, PLC
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:
1194953810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1241 JOHNSON AVE
Provider Second Line Business Mailing Address:
MAIL BOX 312
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-3306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-668-3737
Provider Business Mailing Address Fax Number:
480-699-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14019 S 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85048-4459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-668-3737
Provider Business Practice Location Address Fax Number:
480-699-9383
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
IFTIKHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR AND OWNER
Authorized Official Telephone Number:
480-668-3737

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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