Provider Demographics
NPI:1710322441
Name:WEST COAST PATHOLOGY LABORATORY OF AZ
Entity Type:Organization
Organization Name:WEST COAST PATHOLOGY LABORATORY OF AZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-794-9737
Mailing Address - Street 1:7200 W BELL RD, BLDG E-103
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:800-794-9737
Mailing Address - Fax:510-662-5244
Practice Address - Street 1:712 ALFRED NOBEL DR
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1805
Practice Address - Country:US
Practice Address - Phone:800-794-9737
Practice Address - Fax:510-662-5244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20624606A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory