Healthcare Provider Details

I. General information

NPI: 1124098736
Provider Name (Legal Business Name): LUCENT PATHOLOGY PARTNERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

PO BOX 340850
SACRAMENTO CA
95834-0850
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5275
  • Fax:
Mailing address:
  • Phone: 916-634-7767
  • Fax: 916-672-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFAEL RODRIGUEZ
Title or Position: PRESIDENT AND DIRECTOR
Credential: M.D.
Phone: 916-634-7767