1912930900 NPI number — THOUSAND OAKS PATHOLOGY ASSOCIATES INC

Table of content: (NPI 1912930900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912930900 NPI number — THOUSAND OAKS PATHOLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOUSAND OAKS 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:
1912930900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 39215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90039-2165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-288-8325
Provider Business Mailing Address Fax Number:
419-866-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 ROLLING OAKS DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-373-8582
Provider Business Practice Location Address Fax Number:
805-373-0023
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTHEIS
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
MERRITT
Authorized Official Title or Position:
PATHOLOGIST/MANAGING PARTNER
Authorized Official Telephone Number:
805-373-8582

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  05D1022855 , 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)

  • Identifier: LAB22855F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com