Provider Demographics
NPI:1407938996
Name:ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC
Other - Org Name:PATHOLOGY DIAGNOSTIC CONSULTANTS INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:714-288-4044
Mailing Address - Street 1:5856 CORPORATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4754
Mailing Address - Country:US
Mailing Address - Phone:714-229-7619
Mailing Address - Fax:
Practice Address - Street 1:805 W LA VETA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3928
Practice Address - Country:US
Practice Address - Phone:714-288-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065950Medicaid
CA05D0888613Medicare PIN