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General NPI Number Information
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NPI Number | 1518062082
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Entity Type | Organization
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Legal Business Name | PATHNET ESOTERIC LABORATORY INSTITUTE
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 7247 HAYVENHURST AVE SUITE A3
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City | VAN NUYS
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State | CA
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Zip | 91406-2871
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Country | US
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Telephone | 818-780-6300
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Fax | 818-781-2243
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Provider Business Mailing Address
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Address Line | 7247 HAYVENHURST AVE SUITE A3
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City | VAN NUYS
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State | CA
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Zip | 91406-2871
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Country | US
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Telephone | 818-780-6300
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Fax | 818-781-2243
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. ALAN MITCHELL KAYE
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Credential |
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Telephone | 818-780-6300
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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 | COS800143
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License Number State | TX
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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 | CLF1123
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License Number State | CA
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