Healthcare Provider Details

I. General information

NPI: 1346286226
Provider Name (Legal Business Name): WEST COAST PATHOLOGY OF FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11375 CORTEZ BLVD
BROOKSVILLE FL
34613-5409
US

IV. Provider business mailing address

PO BOX 60100
CHARLESTON SC
29419-0100
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-4614
  • Fax: 770-776-5966
Mailing address:
  • Phone: 305-665-4614
  • Fax: 770-776-5966

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: KATHLEEN MOBLEY
Title or Position: PRESIDENT
Credential: MD
Phone: 352-596-6632