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NPI Code Detail

MEDICARE: DR. JEFFREY BOB VIRGIN M.D., PH.D.

MEDICARE: DR. JEFFREY BOB VIRGIN M.D., PH.D.
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
1207ZP0101XAnatomic Pathology PhysicianMD00028232WA
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianG156025CA

Other Identifiers

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

General Provider Information

NPI Number : 1659460897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY BOB VIRGIN M.D., PH.D.
Provider Business Mailing Address
First Line : 2374 E PACIFICA PL
Second Line :
City : RANCHO DOMINGUEZ
State : CA
Zip : 90220-6214
Country : US
Telephone Number : 310-225-3244
Fax Number : 310-698-7040
Provider Business Practice Location Address
First Line : 2374 E PACIFICA PL
Second Line :
City : RANCHO DOMINGUEZ
State : CA
Zip : 90220-6214
Country : US
Telephone Number : 310-225-3244
Fax Number : 310-698-7040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 09/09/2021

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