Provider Demographics
NPI:1467637942
Name:PATHCARE DIAGNOSTICS INC.
Entity Type:Organization
Organization Name:PATHCARE DIAGNOSTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-306-9936
Mailing Address - Street 1:1810 FULLERTON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3103
Mailing Address - Country:US
Mailing Address - Phone:951-808-8863
Mailing Address - Fax:951-808-0550
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:STE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-808-8863
Practice Address - Fax:951-602-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF332529291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01395ZMedicare PIN