Provider Demographics
NPI:1679659114
Name:ASSOCIATED PATHOLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ASSOCIATED PATHOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-884-2710
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0665
Mailing Address - Country:US
Mailing Address - Phone:408-884-2710
Mailing Address - Fax:408-884-2734
Practice Address - Street 1:1555 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1705
Practice Address - Country:US
Practice Address - Phone:408-884-2710
Practice Address - Fax:408-884-2734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED PATHOLOGY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0606603291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS1327OtherMEDICARE RAILROAD
CAGR0088851Medicaid
CAQ682OtherSAN FRANCISCO HEALTH PLAN
CAZZZ16509ZMedicare PIN