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General NPI Number Information
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NPI Number | 1912991597
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Entity Type | Organization
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Legal Business Name | PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST DEPT OF PATHOLOGY
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-847-6052
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Fax | 818-847-6029
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Provider Business Mailing Address
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Address Line | 2219 W OLIVE AVE # 219
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City | BURBANK
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State | CA
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Zip | 91506-2625
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Country | US
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Telephone | 818-847-6052
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Fax | 323-784-2904
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JOSE M ESTEBAN
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Credential | M.D.
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Telephone | 818-847-6052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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