Provider Demographics
NPI:1609945575
Name:ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ORANGE COUNTY PATHOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SASSOON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:714-288-4044
Mailing Address - Street 1:805 W LA VETA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3928
Mailing Address - Country:US
Mailing Address - Phone:714-288-4044
Mailing Address - Fax:714-288-4042
Practice Address - Street 1:805 W LA VETA AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3928
Practice Address - Country:US
Practice Address - Phone:714-288-4044
Practice Address - Fax:714-288-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0015551Medicaid
CA05D0579177OtherCLIA
CAGR0015550Medicaid
CAGR0015550Medicaid