Provider Demographics
NPI:1184207730
Name:MALIBU PATHOLOGY, INC
Entity Type:Organization
Organization Name:MALIBU PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-497-1335
Mailing Address - Street 1:28222 AGOURA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2484
Mailing Address - Country:US
Mailing Address - Phone:310-497-1335
Mailing Address - Fax:
Practice Address - Street 1:28222 AGOURA RD STE 101
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2484
Practice Address - Country:US
Practice Address - Phone:310-497-1335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory