Provider Demographics
NPI:1497732630
Name:UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP
Entity Type:Organization
Organization Name:UCLA PATHOLOGY AND LABORATORY MEDICINE GROUP
Other - Org Name:UC REGENTS UCLA PATHOLOGY & LAB MED GRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROFESSOR & SR VICE CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-794-7953
Mailing Address - Street 1:FILE 55632
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074
Mailing Address - Country:US
Mailing Address - Phone:310-794-7953
Mailing Address - Fax:
Practice Address - Street 1:10833 LE CONTE AVENUE
Practice Address - Street 2:SUITE B-186 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-794-7953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Multi-Specialty
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Multi-Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Multi-Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083761Medicaid
CAGR0083760Medicaid
CAW14299AMedicare PIN
CAGR0083760Medicaid