Provider Demographics
NPI:1477977080
Name:SPECIALIZED PATHOLOGY LABORATORIES
Entity Type:Organization
Organization Name:SPECIALIZED PATHOLOGY LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-404-2371
Mailing Address - Street 1:17451 BASTANCHURY RD
Mailing Address - Street 2:SUITE: 204-30
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1857
Mailing Address - Country:US
Mailing Address - Phone:714-577-0413
Mailing Address - Fax:714-577-0002
Practice Address - Street 1:17451 BASTANCHURY RD
Practice Address - Street 2:SUITE: 204-30
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-577-0413
Practice Address - Fax:714-577-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00342821207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHC799AMedicare UPIN