Healthcare Provider Details

I. General information

NPI: 1790781110
Provider Name (Legal Business Name): WEST COAST PATHOLOGY LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

IV. Provider business mailing address

712 ALFRED NOBEL DR
HERCULES CA
94547-1805
US

V. Phone/Fax

Practice location:
  • Phone: 510-662-5200
  • Fax:
Mailing address:
  • Phone: 510-662-5214
  • Fax: 510-662-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF 4407
License Number StateCA

VIII. Authorized Official

Name: MRS. CHRISTINE HILL
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 510-662-5200