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General NPI Number Information
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NPI Number | 1053787432
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Entity Type | Organization
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Legal Business Name | LONG BEACH MEMORIAL PATHOLOGY MEDICAL GROUP INC.
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2801 ATLANTIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-1701
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Country | US
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Telephone | 562-933-0716
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Fax |
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Provider Business Mailing Address
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Address Line | FILE 1319: 1801 W OLYMPIC BLVD
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City | PASADENA
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State | CA
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Zip | 91199-1319
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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 | PATHOLOGIST ASSISTANT
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Name | EYDAN TORRES
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Credential |
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Telephone | 562-417-9440
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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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