Provider Demographics
NPI:1407164486
Name:AZTEC PATHOLOGY LLC
Entity Type:Organization
Organization Name:AZTEC PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-806-1500
Mailing Address - Street 1:576 W HORSESHOE PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5119
Mailing Address - Country:US
Mailing Address - Phone:623-806-1500
Mailing Address - Fax:623-433-0174
Practice Address - Street 1:2538 E UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6925
Practice Address - Country:US
Practice Address - Phone:623-806-1500
Practice Address - Fax:623-433-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDY0475OtherMEDICARE RAILROAD PTAN
AZ550735Medicaid