Healthcare Provider Details

I. General information

NPI: 1891914529
Provider Name (Legal Business Name): PATHOLOGY BUSINESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

IV. Provider business mailing address

19951 MARINER AVE SUITE 155
TORRANCE CA
90503-1672
US

V. Phone/Fax

Practice location:
  • Phone: 310-225-3244
  • Fax: 310-698-7054
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7054

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: RENEE CANNON
Title or Position: EXECUTIVE DIRECTOR OF OPERATIONS
Credential:
Phone: 310-225-3270