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General NPI Number Information
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NPI Number | 1447557822
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Entity Type | Organization
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Legal Business Name | PATHLAB SERVICES INC
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Dates
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Enumeration Date | 02/19/2011
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 7707 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4207
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Country | US
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Telephone | 714-902-1762
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Fax | 657-400-9073
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Provider Business Mailing Address
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Address Line | 7707 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4207
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Country | US
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Telephone | 714-902-1762
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Fax | 657-400-9073
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN C HISERODT
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Credential | MD
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Telephone | 714-902-1762
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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 | CLF00340712
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License Number State | CA
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