Provider Demographics
NPI:1952325565
Name:UNIVERSITY PATHOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:UNIVERSITY PATHOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:323-442-1180
Mailing Address - Street 1:2011 ZONAL AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-5364
Mailing Address - Country:US
Mailing Address - Phone:323-442-2582
Mailing Address - Fax:323-442-2588
Practice Address - Street 1:2011 ZONAL AVE,
Practice Address - Street 2:SUITE 209
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0181
Practice Address - Country:US
Practice Address - Phone:323-442-2582
Practice Address - Fax:323-442-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0928654207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 207ZP0104X, 207ZP0105X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Single Specialty
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Single Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Single Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Single Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical PathologyGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0939440OtherCLIA NUMBER
CA05D0928654OtherCLIA ID NUMBER
CACH7107OtherRAILROAD MEDICARE
CAGR0101420Medicaid
CAGR0101421Medicaid
CA05D1065390OtherCLIA NUMBER
CACG4848OtherRAILROAD MEDICARE
CACQ2142OtherRAILROAD MEDICARE
CA05D0058906OtherCLIA
CALAB28654FMedicaid
CA05D0670053OtherCLIA
ID807975000Medicaid
CALAB39440FMedicaid
CACQ2142OtherRAILROAD MEDICARE
CACH7107OtherRAILROAD MEDICARE
CA05D0928654OtherCLIA ID NUMBER
CAGR0101420Medicaid