Provider Demographics
NPI:1932283264
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 REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-884-2712
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:408-399-5010
Mailing Address - Fax:408-884-2734
Practice Address - Street 1:105A COOPER CT
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7604
Practice Address - Country:US
Practice Address - Phone:408-399-5010
Practice Address - Fax:408-884-2734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAOSD0712326207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ682OtherSAN FRANCISCO HEALTH PLAN
CALAB58812FMedicaid
CACH7923OtherMEDICARE RAILROAD
CAZZZ27934ZMedicare PIN