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General NPI Number Information
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NPI Number | 1023396348
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Entity Type | Organization
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Legal Business Name | PACIFIC BREAST PATHOLOGY MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/03/2011
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 101 CALYPSO SHRS
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City | NOVATO
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State | CA
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Zip | 94949-5344
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Country | US
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Telephone | 650-238-4033
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CALYPSO SHRS
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City | NOVATO
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State | CA
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Zip | 94949-5344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. PHILIP DUTT
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Credential | MD
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Telephone | 650-238-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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