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General NPI Number Information
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NPI Number | 1124316138
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Entity Type | Organization
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Legal Business Name | PATH MD INC
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 931 BUENA VISTA ST STE 200A
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City | DUARTE
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State | CA
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Zip | 91010-1713
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Country | US
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Telephone | 424-302-3307
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Fax | 323-944-0639
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Provider Business Mailing Address
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Address Line | PO BOX 745229
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City | LOS ANGELES
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State | CA
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Zip | 90074-5229
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Country | US
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Telephone | 424-302-3307
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Fax | 323-944-0639
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Authorized Official
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Title or Position | OWNER
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Name | SIAMAK TABIB
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Credential |
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Telephone | 310-652-4472
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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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