Provider Demographics
NPI:1730356759
Name:PATHWAY DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:PATHWAY DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:THIELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-774-3555
Mailing Address - Street 1:3003 MALIBU CANYON RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4760
Mailing Address - Country:US
Mailing Address - Phone:310-774-3555
Mailing Address - Fax:310-774-3551
Practice Address - Street 1:3003 MALIBU CANYON RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4760
Practice Address - Country:US
Practice Address - Phone:310-774-3555
Practice Address - Fax:310-774-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11824291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory