Healthcare Provider Details

I. General information

NPI: 1184207730
Provider Name (Legal Business Name): MALIBU PATHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28720 ROADSIDE DR STE 250
AGOURA HILLS CA
91301-4572
US

IV. Provider business mailing address

28720 ROADSIDE DR STE 250
AGOURA HILLS CA
91301-4572
US

V. Phone/Fax

Practice location:
  • Phone: 310-497-1335
  • Fax:
Mailing address:
  • Phone: 310-497-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MAN LI
Title or Position: MEDICAL LAB DIRECTOR
Credential: PHD
Phone: 310-497-1335