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General NPI Number Information
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NPI Number | 1477977080
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Entity Type | Organization
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Legal Business Name | SPECIALIZED PATHOLOGY LABORATORIES
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Dates
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Enumeration Date | 02/18/2014
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Last Update Date | 02/18/2014
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Provider Practice Location Address
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Address Line | 17451 BASTANCHURY RD SUITE: 204-30
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City | YORBA LINDA
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State | CA
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Zip | 92886-1857
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Country | US
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Telephone | 714-577-0413
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Fax | 714-577-0002
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Provider Business Mailing Address
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Address Line | 17451 BASTANCHURY RD SUITE: 204-30
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City | YORBA LINDA
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State | CA
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Zip | 92886-1857
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Country | US
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Telephone | 714-577-0413
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Fax | 714-577-0002
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | SHEHLA ARAIN
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Credential | M.D.
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Telephone | 714-404-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 00342821
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License Number State | CA
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