Provider Demographics
NPI:1689604118
Name:PATHOLOGY GROUP OF ST. JOHN'S HEALTH CENTER
Entity Type:Organization
Organization Name:PATHOLOGY GROUP OF ST. JOHN'S HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-8101
Mailing Address - Street 1:1328 22ND ST
Mailing Address - Street 2:DEPT. OF PATHOLOGY, ST. JOHN'S HEALTH CENTER
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2032
Mailing Address - Country:US
Mailing Address - Phone:310-829-8101
Mailing Address - Fax:310-829-6509
Practice Address - Street 1:1328 22ND ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2032
Practice Address - Country:US
Practice Address - Phone:310-829-8101
Practice Address - Fax:310-829-6509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76693282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access