Provider Demographics
NPI:1417023409
Name:PATHOLOGY & LABORATORY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PATHOLOGY & LABORATORY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORLANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-725-4211
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:714-236-4000
Mailing Address - Fax:714-236-4006
Practice Address - Street 1:309 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4308
Practice Address - Country:US
Practice Address - Phone:323-725-4211
Practice Address - Fax:323-889-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066850Medicaid
CAZZZ02790ZOtherBLUE SHIELD
CAGR0066850Medicaid
CAGR0066850Medicaid