Healthcare Provider Details

I. General information

NPI: 1235245291
Provider Name (Legal Business Name): OMNIPATHOLOGY SOLUTIONS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 S FAIR OAKS AVE
PASADENA CA
91105-2626
US

IV. Provider business mailing address

968 S FAIR OAKS AVE
PASADENA CA
91105-2626
US

V. Phone/Fax

Practice location:
  • Phone: 626-744-5339
  • Fax: 866-296-6833
Mailing address:
  • Phone: 626-744-5339
  • Fax: 866-296-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF332126
License Number StateCA

VIII. Authorized Official

Name: CLAIRE DAVID
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 661-705-3441