Healthcare Provider Details

I. General information

NPI: 1922079706
Provider Name (Legal Business Name): CLIN-PATH PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 S 56TH ST STE 110
PHOENIX AZ
85034-2177
US

IV. Provider business mailing address

PO BOX 29650 DEPT #880445
PHOENIX AZ
85038
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-5211
  • Fax: 602-685-5325
Mailing address:
  • Phone: 623-266-7770
  • Fax: 623-322-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BEA SONTHIPANYA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-478-8057