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General NPI Number Information
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NPI Number | 1730356759
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Entity Type | Organization
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Legal Business Name | PATHWAY DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 3003 MALIBU CANYON RD
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City | MALIBU
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State | CA
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Zip | 90265-4760
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Country | US
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Telephone | 310-774-3555
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Fax | 310-774-3551
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Provider Business Mailing Address
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Address Line | 3003 MALIBU CANYON RD
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City | MALIBU
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State | CA
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Zip | 90265-4760
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Country | US
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Telephone | 310-774-3555
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Fax | 310-774-3551
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Authorized Official
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Title or Position | CFO
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Name | BART THIELEN
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Credential |
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Telephone | 310-774-3555
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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 | CLF11824
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License Number State | CA
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