Basic Information
| Provider Information | |||||||||
| NPI: | 1801039250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY SCIENCE MEDICAL GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5240 E BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900222002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265705752 | ||||||||
| FaxNumber: | 6264582004 | ||||||||
| Practice Location | |||||||||
| Address1: | 5240 E BEVERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900222002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265705752 | ||||||||
| FaxNumber: | 6264582004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2009 | ||||||||
| LastUpdateDate: | 04/15/2009 | ||||||||
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| AuthorizedOfficialLastName: | ZEPEDA | ||||||||
| AuthorizedOfficialFirstName: | MOISES | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6265705752 | ||||||||
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| 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 | A62532 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.