1699834614 NPI number — DERMPATH LAB UCI

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 1699834614 NPI number — DERMPATH LAB UCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DERMPATH LAB UCI
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:
1699834614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5856 CORPORATE AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-236-4000
Provider Business Mailing Address Fax Number:
714-236-4006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DRIVE
Provider Second Line Business Practice Location Address:
BLDG 52
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-5557
Provider Business Practice Location Address Fax Number:
714-456-8859
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYSON
Authorized Official First Name:
SENAIT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-456-5557

Provider Taxonomy Codes

  • Taxonomy code: 207ZD0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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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