Healthcare Provider Details

I. General information

NPI: 1407317175
Provider Name (Legal Business Name): PATHOLOGY PROCESSING LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

IV. Provider business mailing address

710 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

V. Phone/Fax

Practice location:
  • Phone: 510-662-5214
  • Fax:
Mailing address:
  • Phone: 510-662-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HILL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 510-662-5214