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General NPI Number Information
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NPI Number | 1922079706
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Entity Type | Organization
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Legal Business Name | CLIN-PATH PATHOLOGY
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 424 S 56TH ST STE 110
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City | PHOENIX
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State | AZ
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Zip | 85034-2177
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Country | US
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Telephone | 602-685-5211
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Fax | 602-685-5325
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Provider Business Mailing Address
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Address Line | PO BOX 29650 DEPT #880445
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City | PHOENIX
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State | AZ
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Zip | 85038
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Country | US
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Telephone | 623-266-7770
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Fax | 623-322-4639
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MS. BEA SONTHIPANYA
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Credential |
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Telephone | 480-478-8057
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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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Taxonomy #2
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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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