Healthcare Provider Details

I. General information

NPI: 1407938996
Provider Name (Legal Business Name): ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W LA VETA AVE SUITE 104
ORANGE CA
92868-3928
US

IV. Provider business mailing address

5856 CORPORATE AVE SUITE 200
CYPRESS CA
90630-4754
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-4044
  • Fax:
Mailing address:
  • Phone: 714-229-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AARON SASSOON
Title or Position: PRESIDENT
Credential: PHD MD
Phone: 714-288-4044