Provider Demographics
NPI:1528056926
Name:NETWORK CYTOPATHOLOGY SERVICES
Entity type:Organization
Organization Name:NETWORK CYTOPATHOLOGY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:SPRING
Authorized Official - Last Name:VENEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:CT(ASCP)
Authorized Official - Phone:909-394-9010
Mailing Address - Street 1:301 E ARROW HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3364
Mailing Address - Country:US
Mailing Address - Phone:909-394-9010
Mailing Address - Fax:909-394-4830
Practice Address - Street 1:301 E ARROW HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3364
Practice Address - Country:US
Practice Address - Phone:909-394-9010
Practice Address - Fax:909-394-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11100291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB07434FMedicaid