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NPI Code Detail

MEDICARE: PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA

MEDICARE: PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
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

General Provider Information

NPI Number : 1912991597
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Provider Business Mailing Address
First Line : 2219 W OLIVE AVE # 219
Second Line :
City : BURBANK
State : CA
Zip : 91506-2625
Country : US
Telephone Number : 818-847-6052
Fax Number : 323-784-2904
Provider Business Practice Location Address
First Line : 501 S BUENA VISTA ST
Second Line : DEPT OF PATHOLOGY
City : BURBANK
State : CA
Zip : 91505-4809
Country : US
Telephone Number : 818-847-6052
Fax Number : 818-847-6029
Authorized Official
Title or Position : MANAGING PARTNER
Name : JOSE M ESTEBAN
Credential : M.D.
Telephone Number : 818-847-6052
Provider Enumeration Date : 09/09/2005
Last Update Date : 04/26/2017

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1356335814 — KATHLEEN M MAKAREWICZ M.D.
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BURBANK, CA
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1841284312 — CARL D WINBERG M.D.
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1952395402 — JOSE M ESTEBAN M.D.
Practice Location Address:
501 S BUENA VISTA ST , DEPT OF PATHOLOGY
BURBANK, CA
91505-4809
Practice Phone: 818-847-6052
Practice Fax: 818-847-6029

Directions to “PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA ” Practice Location

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