Basic Information
Provider Information
NPI: 1528488756
EntityType: 2
ReplacementNPI:  
OrganizationName: WESTPATH
LastName:  
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Credential:  
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Mailing Information
Address1: 5700 SOUTHWYCK BLVD
Address2:  
City: TOLEDO
State: OH
PostalCode: 436141509
CountryCode: US
TelephoneNumber: 8005361197
FaxNumber:  
Practice Location
Address1: 7300 MEDICAL CENTER DR
Address2:  
City: WEST HILLS
State: CA
PostalCode: 913071902
CountryCode: US
TelephoneNumber: 8186764000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/28/2014
LastUpdateDate: 04/28/2014
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: PESSELNICK
AuthorizedOfficialFirstName: GARY
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AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8186764000
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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