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General NPI Number Information
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NPI Number | 1174836894
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Entity Type | Organization
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Legal Business Name | SAN DIEGO PATHOLOGISTS MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 7592 METROPOLITAN DR SUITE 405
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City | SAN DIEGO
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State | CA
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Zip | 92108-4428
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Country | US
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Telephone | 619-325-8726
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Fax | 619-325-8728
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Provider Business Mailing Address
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Address Line | PO BOX 744127
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City | DALLAS
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State | TX
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Zip | 75374-4127
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Country | US
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Telephone | 619-325-8726
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Fax | 619-325-8728
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLA J. STAYBOLDT
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Credential | M.D.
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Telephone | 619-325-8726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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