Provider Demographics
NPI:1548325145
Name:TRUPATH LABORATORIES, INC.
Entity type:Organization
Organization Name:TRUPATH LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHDIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-6500
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3120
Mailing Address - Country:US
Mailing Address - Phone:951-734-6500
Mailing Address - Fax:951-734-6555
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:SUITE 2G
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-734-6500
Practice Address - Fax:951-734-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1050319291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51277Medicare UPIN
CAZZZ03458ZMedicare ID - Type Unspecified