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General NPI Number Information
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NPI Number | 1386807246
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Entity Type | Organization
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Legal Business Name | INTERSCOPE PATHOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 30700 RUSSELL RANCH RD SUITE 250, UNIT 235
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-5907
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Country | US
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Telephone | 818-992-7848
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Fax | 818-992-7748
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Provider Business Mailing Address
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Address Line | 30700 RUSSELL RANCH RD STE 250
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-9507
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Country | US
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Telephone | 818-992-7848
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Fax | 818-992-7943
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALAN S BRICKLIN
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Credential | MD
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Telephone | 818-992-7848
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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 | CLF3199
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License Number State | CA
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