Provider Demographics
NPI:1508132366
Name:ARROWHEAD PATHOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ARROWHEAD PATHOLOGY MEDICAL GROUP, INC.
Other - Org Name:HERBERT BRAUNSTEIN M.D. AND ROBRT A. STEWART, M.D. INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-580-0010
Mailing Address - Street 1:400 N. PEPPER AVE.
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1819
Mailing Address - Country:US
Mailing Address - Phone:909-580-0010
Mailing Address - Fax:909-580-0064
Practice Address - Street 1:400 N. PEPPER AVE.
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1819
Practice Address - Country:US
Practice Address - Phone:909-580-0010
Practice Address - Fax:909-580-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC0625387207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty