Healthcare Provider Details

I. General information

NPI: 1417016833
Provider Name (Legal Business Name): PATHOLOGY MEDICAL GROUP OF RIVERSIDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE RIVERSIDE COMMUNITY HOSPITAL
RIVERSIDE CA
92501
US

IV. Provider business mailing address

PO BOX 260071
SAINT LOUIS MO
63126-8071
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3243
  • Fax: 951-788-3633
Mailing address:
  • Phone: 314-849-3535
  • Fax: 844-410-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARREN OKADA
Title or Position: OWNER - MEDICAL DIRECTOR
Credential: MD
Phone: 951-788-3243