MEDICARE: BAY AREA PATHOLOGY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	CLF339359	CA

General Provider Information

NPI Number	:	1023340619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA PATHOLOGY GROUP

Provider Business Mailing Address
First Line	:	1825 CIVIC CENTER DR STE 7
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-7302
Country	:	US
Telephone Number	:	408-236-3505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 CIVIC CENTER DR STE 7
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-7302
Country	:	US
Telephone Number	:	408-236-3505
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIA HASHEMIEH
Credential	:
Telephone Number	:	408-236-3505

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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