Healthcare Provider Details

I. General information

NPI: 1093572539
Provider Name (Legal Business Name): LOS PALOS PATHOLOGY LAB AND ANCILLARY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 LOS PALOS DR STE 5
SALINAS CA
93901-3916
US

IV. Provider business mailing address

1083 LOS PALOS DR STE 5
SALINAS CA
93901-3916
US

V. Phone/Fax

Practice location:
  • Phone: 831-800-7887
  • Fax: 831-998-7155
Mailing address:
  • Phone: 831-594-1537
  • Fax: 831-998-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. RAQUEL M SISAYAN
Title or Position: COO
Credential:
Phone: 831-594-1537