Provider Demographics
NPI:1447557822
Name:PATHLAB SERVICES INC
Entity Type:Organization
Organization Name:PATHLAB SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HISERODT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-902-1762
Mailing Address - Street 1:7707 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4207
Mailing Address - Country:US
Mailing Address - Phone:714-902-1762
Mailing Address - Fax:657-400-9073
Practice Address - Street 1:7707 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4207
Practice Address - Country:US
Practice Address - Phone:714-902-1762
Practice Address - Fax:657-400-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00340712291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory