Basic Information
| Provider Information | |||||||||
| NPI: | 1437211646 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONTRA COSTA PATHOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1440 | ||||||||
| Address2: | |||||||||
| City: | SUISUN CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945854440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109640458 | ||||||||
| FaxNumber: | 5109640476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 YGNACIO VALLEY RD # 201 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259393000 | ||||||||
| FaxNumber: | 5109640476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LARNER | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9259393300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.