Basic Information
| Provider Information | |||||||||
| NPI: | 1184618829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G I VARAPRASATHAN MD A PROF CORP | ||||||||
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| OtherOrganizationName: | PATHOLOGY CYTOPATHOLOGY SERVICES MEDICAL GROUP, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10076 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914100076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055788300 | ||||||||
| FaxNumber: | 8055783911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W AVENUE J | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619495611 | ||||||||
| FaxNumber: | 6619495904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | VARAPRASATHAN | ||||||||
| AuthorizedOfficialFirstName: | G. | ||||||||
| AuthorizedOfficialMiddleName: | I. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6619495611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | GR0013581 | 05 | CA | MEDICAID |