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General NPI Number Information
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NPI Number | 1346395779
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Entity Type | Organization
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Legal Business Name | CORONA PATHOLOGY SERVICES
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 4444 W RIVERSIDE DR SUITE 308
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City | BURBANK
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State | CA
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Zip | 91505-4073
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Country | US
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Telephone | 818-566-1891
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Fax | 818-566-8834
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Provider Business Mailing Address
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Address Line | 4444 W RIVERSIDE DR SUITE 308
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City | BURBANK
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State | CA
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Zip | 91505-4073
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Country | US
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Telephone | 818-566-1891
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Fax | 818-566-8834
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Authorized Official
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Title or Position | CEO
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Name | MR. KAMAL ALI WAHEB
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Credential |
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Telephone | 818-402-8060
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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 | 05D0879836
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF00003712
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License Number State | CA
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