MEDICARE: WEST COAST PATHOLOGY LABORATORY INC

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	CLF 4407	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1790781110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST COAST PATHOLOGY LABORATORY INC

Provider Business Mailing Address
First Line	:	712 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1805
Country	:	US
Telephone Number	:	510-662-5214
Fax Number	:	510-662-5241

Provider Business Practice Location Address
First Line	:	712 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1805
Country	:	US
Telephone Number	:	510-662-5200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. CHRISTINE HILL
Credential	:
Telephone Number	:	510-662-5200

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/20/2016

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