1457449365 NPI number — PACIFIC RIM PATHOLOGY MEDICAL CORPORATION

Table of content: (NPI 1457449365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457449365 NPI number — PACIFIC RIM PATHOLOGY MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC RIM PATHOLOGY MEDICAL CORPORATION
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:
1457449365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 1440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91199-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-939-3660
Provider Business Mailing Address Fax Number:
619-502-3573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5325 METRO ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92110-2608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-939-3660
Provider Business Practice Location Address Fax Number:
619-502-3573
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARRY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-939-3660

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LAB85442F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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