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NPI Code Detail

MEDICARE: SAN GABRIEL VALLEY CONSULTING PATHOLOGISTS MEDICAL GROUP, INC.

MEDICARE: SAN GABRIEL VALLEY CONSULTING PATHOLOGISTS MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0500XCytopathology Physician
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ39583ZOTHERCABLUE SHIELD GROUP ID
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538128053
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN GABRIEL VALLEY CONSULTING PATHOLOGISTS MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 10076
Second Line :
City : VAN NUYS
State : CA
Zip : 91410-0076
Country : US
Telephone Number : 805-578-8300
Fax Number : 805-578-8950
Provider Business Practice Location Address
First Line : 250 S GRAND AVE
Second Line :
City : GLENDORA
State : CA
Zip : 91741-4218
Country : US
Telephone Number : 626-857-3120
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ARTHUR H WILLIAMS
Credential : MD
Telephone Number : 626-857-3120
Provider Enumeration Date : 03/22/2006
Last Update Date : 10/24/2023

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