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General NPI Number Information
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NPI Number | 1508828658
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Entity Type | Organization
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Legal Business Name | PREMIER PATHOLOGY LABORATORIES INC
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 01/07/2009
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Provider Practice Location Address
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Address Line | 1401 GARCES HWY
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City | DELANO
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State | CA
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Zip | 93215-3690
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Country | US
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Telephone | 559-781-5174
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10076
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City | VAN NUYS
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State | CA
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Zip | 91410-0076
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-8950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBRA HANKS
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Credential | MD
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Telephone | 559-781-5174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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