Healthcare Provider Details

I. General information

NPI: 1275546129
Provider Name (Legal Business Name): VALLEY PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-6383
  • Fax: 951-765-4829
Mailing address:
  • Phone: 951-925-6383
  • Fax: 951-765-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALAN MARE
Title or Position: PATHOLOGIST
Credential: M.D.
Phone: 951-925-6383