Provider Demographics
NPI:1225892292
Name:PATH, JUSTIN J (CPT1)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:J
Last Name:PATH
Suffix:
Gender:M
Credentials:CPT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 BIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3881
Mailing Address - Country:US
Mailing Address - Phone:530-738-3474
Mailing Address - Fax:
Practice Address - Street 1:1459 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1304
Practice Address - Country:US
Practice Address - Phone:707-442-0881
Practice Address - Fax:707-442-1084
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02392352246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty