Healthcare Provider Details

I. General information

NPI: 1366549016
Provider Name (Legal Business Name): LAGUNA PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

PO BOX 7630
LAGUNA NIGUEL CA
92607-7630
US

V. Phone/Fax

Practice location:
  • Phone: 949-499-7181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER VANLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-499-7181