Basic Information
| Provider Information | |||||||||
| NPI: | 1154350932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLIN-PATH DIAGNOSTICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42210 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238897403 | ||||||||
| FaxNumber: | 6238897407 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 S. 48TH STREET | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024242889 | ||||||||
| FaxNumber: | 6024242569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | DE LA TORRE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 6026855211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 207ZP0102X | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.