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
State | License ID | Taxonomies |
---|---|---|
CA | 05D0928654 | 207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZH0000X, 207ZI0100X, 207ZM0300X, 207ZN0500X, 207ZP0007X, 207ZP0101X, 207ZP0102X, 207ZP0104X, 207ZP0105X, 207ZP0213X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Single Specialty |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Single Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Single Specialty |
No | 207ZD0900X | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | Group - Single Specialty |
No | 207ZF0201X | Allopathic & Osteopathic Physicians | Pathology | Forensic Pathology | Group - Single Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Single Specialty |
No | 207ZI0100X | Allopathic & Osteopathic Physicians | Pathology | Immunopathology | Group - Single Specialty |
No | 207ZM0300X | Allopathic & Osteopathic Physicians | Pathology | Medical Microbiology | Group - Single Specialty |
No | 207ZN0500X | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | Group - Single Specialty |
No | 207ZP0007X | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | Group - Single Specialty |
No | 207ZP0101X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | Group - Single Specialty |
No | 207ZP0104X | Allopathic & Osteopathic Physicians | Pathology | Chemical Pathology | Group - Single Specialty |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Single Specialty |
No | 207ZP0213X | Allopathic & Osteopathic Physicians | Pathology | Pediatric Pathology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 05D0939440 | Other | CLIA NUMBER |
CA | 05D0928654 | Other | CLIA ID NUMBER |
CA | CH7107 | Other | RAILROAD MEDICARE |
CA | GR0101420 | Medicaid | |
CA | GR0101421 | Medicaid | |
CA | 05D1065390 | Other | CLIA NUMBER |
CA | CG4848 | Other | RAILROAD MEDICARE |
CA | CQ2142 | Other | RAILROAD MEDICARE |
CA | 05D0058906 | Other | CLIA |
CA | LAB28654F | Medicaid | |
CA | 05D0670053 | Other | CLIA |
ID | 807975000 | Medicaid | |
CA | LAB39440F | Medicaid | |
CA | CQ2142 | Other | RAILROAD MEDICARE |
CA | CH7107 | Other | RAILROAD MEDICARE |
CA | 05D0928654 | Other | CLIA ID NUMBER |
CA | GR0101420 | Medicaid |