Provider Demographics
NPI:1275533085
Name:WEST COAST CLINICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:WEST COAST CLINICAL LABORATORIES, INC.
Other - Org Name:PATHOLOGY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-225-3148
Mailing Address - Street 1:19951 MARINER AVENUE SUITE 175
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1738
Mailing Address - Country:US
Mailing Address - Phone:310-225-3190
Mailing Address - Fax:310-380-7165
Practice Address - Street 1:19951 MARINER AVENUE SUITE 175
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1738
Practice Address - Country:US
Practice Address - Phone:310-225-3190
Practice Address - Fax:310-380-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF422291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0642839OtherCLIA
CALAB58770FMedicaid
CAX558770Medicare PIN
CAX558770Medicare UPIN