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NPI Code Detail

MEDICARE: CITRUS PATHOLOGY MEDICAL GROUP

MEDICARE: CITRUS PATHOLOGY MEDICAL 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265426928
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITRUS PATHOLOGY MEDICAL GROUP
Provider Business Mailing Address
First Line : 1420 S CENTRAL AVE
Second Line : DEPT OF PATHOLOGY
City : GLENDALE
State : CA
Zip : 91204-2508
Country : US
Telephone Number : 818-502-2321
Fax Number : 818-409-7708
Provider Business Practice Location Address
First Line : 1420 S CENTRAL AVE
Second Line : DEPT OF PATHOLOGY
City : GLENDALE
State : CA
Zip : 91204-2508
Country : US
Telephone Number : 818-502-2321
Fax Number : 818-409-7708
Authorized Official
Title or Position : MANAGING PARTNER
Name : KENNETH A FRANKEL
Credential : M.D.
Telephone Number : 909-599-6811
Provider Enumeration Date : 09/08/2005
Last Update Date : 01/30/2014

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Directions to “CITRUS PATHOLOGY MEDICAL GROUP ” Practice Location

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