=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841365129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED PATHOLOGY MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 06/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 NEILSON ST
-----------------------------------------------------
City | WATSONVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95076-2468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-884-2710
-----------------------------------------------------
Fax | 408-884-2734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 665
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95031-0665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-884-2710
-----------------------------------------------------
Fax | 408-884-2734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | LIZ SANDOVAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-884-2710
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------