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General NPI Number Information
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NPI Number | 1831254697
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PATHOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 3816 WOODRUFF AVE
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City | LONG BEACH
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State | CA
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Zip | 90808-2147
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Country | US
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Telephone | 562-377-0389
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Fax | 562-425-7618
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Provider Business Mailing Address
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Address Line | 3816 WOODRUFF AVE
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City | LONG BEACH
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State | CA
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Zip | 90808-2147
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Country | US
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Telephone | 562-377-0389
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Fax | 562-425-7618
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRVING FELDAKMP IV
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Credential | MD
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Telephone | 562-862-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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