Provider Demographics
NPI:1053507442
Name:NORTHERN CALIFORNIA UROPATHOLOGY PC
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA UROPATHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-734-8726
Mailing Address - Street 1:802 B ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3026
Mailing Address - Country:US
Mailing Address - Phone:415-734-8726
Mailing Address - Fax:415-762-4220
Practice Address - Street 1:802 B ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3026
Practice Address - Country:US
Practice Address - Phone:415-734-8726
Practice Address - Fax:415-762-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98379291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory