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General NPI Number Information
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NPI Number | 1699085290
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Entity Type | Organization
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Legal Business Name | HISTOPATHOLOGY SERVICES INC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 15012 RED HILL AVE SUITE 8H
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City | TUSTIN
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State | CA
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Zip | 92780-6524
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Country | US
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Telephone | 949-415-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 15012 RED HILL AVENUE SUITE 8H
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 949-415-2535
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | KHODADAD MEHRAEIN
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Credential | MD
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Telephone | 949-415-2535
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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 |
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License Number State |
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