Healthcare Provider Details

I. General information

NPI: 1902269483
Provider Name (Legal Business Name): AFFILIATED PATHOLOGISTS OF THE CENTRAL COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 S HIGUERA ST
SAN LUIS OBISPO CA
93401-7462
US

IV. Provider business mailing address

PO BOX 5007
SAN LUIS OBISPO CA
93403-5007
US

V. Phone/Fax

Practice location:
  • Phone: 805-710-7308
  • Fax:
Mailing address:
  • Phone: 805-710-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology 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: WENDY ANTONIO
Title or Position: BOOKKEEPER
Credential:
Phone: 805-710-7308