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General NPI Number Information
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NPI Number | 1184618878
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Entity Type | Organization
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Legal Business Name | EAST SIDE PATHOLOGY ASSOCIATES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 5240 E BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-2002
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Country | US
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Telephone | 626-307-7875
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Fax | 626-307-7875
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Provider Business Mailing Address
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Address Line | 5240 E BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-2002
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Country | US
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Telephone | 626-307-7875
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Fax | 626-307-7875
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOISES R ZEPEDA
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Credential | M.D.
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Telephone | 626-307-7875
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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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