Provider Demographics
NPI:1700322500
Name:DIAGNOSTIX PREMIUM PATHOLOGY PARTNERS, INC
Entity type:Organization
Organization Name:DIAGNOSTIX PREMIUM PATHOLOGY PARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-805-2097
Mailing Address - Street 1:550 MARINA PKWY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4069
Mailing Address - Country:US
Mailing Address - Phone:412-805-2097
Mailing Address - Fax:
Practice Address - Street 1:37646 COLLEGE DR # B3-104
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-2943
Practice Address - Country:US
Practice Address - Phone:412-805-2097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty