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General NPI Number Information
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NPI Number | 1588691414
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Entity Type | Organization
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Legal Business Name | CONSULTANTS FOR PATH & LAB MED INC, A MEDICAL GROUP
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 8700 BEVERLY BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-1804
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Country | US
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Telephone | 310-423-6627
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Fax | 310-423-0170
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Provider Business Mailing Address
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Address Line | 31255 CEDAR VALLEY DR SUITE 324
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-4014
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Country | US
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Telephone | 818-338-8103
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Fax | 818-338-8119
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAHUL B AMIN
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Credential | M.D.
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Telephone | 310-423-6627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C62183
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License Number State | CA
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