Healthcare Provider Details

I. General information

NPI: 1598081424
Provider Name (Legal Business Name): SOC PATHOLOGY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 E PACIFICA PL
RANCHO DOMINGUEZ CA
90220-6214
US

IV. Provider business mailing address

2374 E PACIFICA PL
RANCHO DOMINGUEZ CA
90220-6214
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3221
  • Fax: 310-698-7040
Mailing address:
  • Phone: 310-225-3221
  • Fax: 310-698-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES B HARRIS
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 310-225-3221