Provider Demographics
NPI:1912045436
Name:CALIFORNIA CYTOLOGY CENTER
Entity Type:Organization
Organization Name:CALIFORNIA CYTOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-588-1231
Mailing Address - Street 1:7507 SEVILLE AVE # 5
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6027
Mailing Address - Country:US
Mailing Address - Phone:323-588-1231
Mailing Address - Fax:323-588-1232
Practice Address - Street 1:7507.5 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255
Practice Address - Country:US
Practice Address - Phone:323-588-1231
Practice Address - Fax:323-588-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF201291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF201OtherSTATE LAB LICENSE
CALAB48121FMedicaid
CACLF201OtherSTATE LAB LICENSE