=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932427564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHKARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2010
-----------------------------------------------------
Last Update Date | 07/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 N TUSTIN AVE STE 101
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-293-3053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 N TUSTIN AVE STE 101
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92705-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-293-3053
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ZAHRA GHAFARI
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 949-293-3053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | CLF339740
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------