Provider Demographics
NPI:1902098221
Name:PATHOLOGY SCIENCE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PATHOLOGY SCIENCE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-570-5752
Mailing Address - Street 1:PO BOX 2311
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-2311
Mailing Address - Country:US
Mailing Address - Phone:818-718-9500
Mailing Address - Fax:818-718-9507
Practice Address - Street 1:5240 E BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2002
Practice Address - Country:US
Practice Address - Phone:626-570-5752
Practice Address - Fax:626-458-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty