Provider Demographics
NPI:1598098238
Name:ALLIEDPATH
Entity Type:Organization
Organization Name:ALLIEDPATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTORY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLASSCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-885-5398
Mailing Address - Street 1:3829 LUNA CT
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3865
Mailing Address - Country:US
Mailing Address - Phone:626-791-6202
Mailing Address - Fax:
Practice Address - Street 1:10455 PACIFIC CENTER CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4339
Practice Address - Country:US
Practice Address - Phone:858-768-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79154291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory