Healthcare Provider Details

I. General information

NPI: 1205162955
Provider Name (Legal Business Name): SONORAN DESERT PATHOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S ATLANTIC BLVD STE A
MONTEREY PARK CA
91754-4750
US

IV. Provider business mailing address

810 S ATLANTIC BLVD STE A
MONTEREY PARK CA
91754-4750
US

V. Phone/Fax

Practice location:
  • Phone: 954-800-1000
  • Fax: 954-800-1111
Mailing address:
  • Phone: 954-800-1000
  • Fax: 954-800-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberCLF 4029
License Number StateCA

VIII. Authorized Official

Name: ROBERT M. GERSTEIN
Title or Position: MANAGING PARTNER
Credential: MANAGING MEMBER
Phone: 954-800-1000