Provider Demographics
NPI:1275546129
Name:VALLEY PATHOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:VALLEY PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-925-6383
Mailing Address - Street 1:1117 E DEVONSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3083
Mailing Address - Country:US
Mailing Address - Phone:951-925-6383
Mailing Address - Fax:951-765-4829
Practice Address - Street 1:1117 E DEVONSHIRE AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3083
Practice Address - Country:US
Practice Address - Phone:951-925-6383
Practice Address - Fax:951-765-4829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071512Medicaid
CAGR0071510Medicaid
CAGR0071511Medicaid
CAGR0071511Medicaid
CAGR0071512Medicaid
CAZZZ13386ZMedicare PIN