Provider Demographics
NPI:1790781110
Name:WEST COAST PATHOLOGY LABORATORY INC
Entity Type:Organization
Organization Name:WEST COAST PATHOLOGY LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-662-5200
Mailing Address - Street 1:712 ALFRED NOBEL DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1805
Mailing Address - Country:US
Mailing Address - Phone:510-662-5214
Mailing Address - Fax:510-662-5241
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:510-662-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 4407291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB58423FMedicaid
CALAB58423FMedicaid