Provider Demographics
NPI:1376062141
Name:UNIVERSITY DERMATOPATHOLOGY SERVICES INC
Entity Type:Organization
Organization Name:UNIVERSITY DERMATOPATHOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-935-8800
Mailing Address - Street 1:8950 W OLYMPIC BLVD STE 171
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3565
Mailing Address - Country:US
Mailing Address - Phone:323-935-8800
Mailing Address - Fax:
Practice Address - Street 1:2740 W MAGNOLIA BLVD UNIT 201
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3051
Practice Address - Country:US
Practice Address - Phone:323-935-8800
Practice Address - Fax:323-935-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73000207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty