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General NPI Number Information
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NPI Number | 1932438140
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Entity Type | Organization
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Legal Business Name | MEMORIAL PATHOLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 14900 IMPERIAL HWY
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City | LA MIRADA
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State | CA
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Zip | 90638-2172
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Country | US
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Telephone | 562-944-1900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10076
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City | VAN NUYS
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State | CA
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Zip | 91410-0076
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Country | US
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Telephone | 805-578-8300
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Fax | 805-578-3911
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM POWER
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Credential | MD
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Telephone | 562-907-1742
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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 | 05D0897627
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License Number State | CA
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