Provider Demographics
NPI:1457449365
Name:PACIFIC RIM PATHOLOGY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC RIM PATHOLOGY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-939-3660
Mailing Address - Street 1:FILE 1440
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1440
Mailing Address - Country:US
Mailing Address - Phone:858-939-3660
Mailing Address - Fax:619-502-3573
Practice Address - Street 1:5325 METRO ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2608
Practice Address - Country:US
Practice Address - Phone:858-939-3660
Practice Address - Fax:619-502-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB85442FMedicaid
CA05D0885442Medicare PIN