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General NPI Number Information
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NPI Number | 1407813777
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Entity Type | Organization
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Legal Business Name | HISTO-PATH TECHNICAL SPECIALTIES, INC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 4847 KIERNAN CT STE 1
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City | SALIDA
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State | CA
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Zip | 95368-9524
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Provider Business Mailing Address
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Address Line | PO BOX 4978
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City | MODESTO
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State | CA
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Zip | 95352-4978
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Authorized Official
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Title or Position | VP, BILLING MGR
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Name | LISA MICHELLE DANIEL
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Credential |
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Telephone | 209-522-8240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QH0600X
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Taxonomy Name | Histology Specialist/Technologist
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License Number |
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License Number State |
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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 |
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License Number State |
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