Provider Demographics
NPI:1902269483
Name:AFFILIATED PATHOLOGISTS OF THE CENTRAL COAST
Entity Type:Organization
Organization Name:AFFILIATED PATHOLOGISTS OF THE CENTRAL COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-710-7308
Mailing Address - Street 1:PO BOX 22405
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0405
Mailing Address - Country:US
Mailing Address - Phone:805-710-7308
Mailing Address - Fax:
Practice Address - Street 1:3701 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7462
Practice Address - Country:US
Practice Address - Phone:805-710-7308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty