Provider Demographics
NPI:1265426928
Name:CITRUS PATHOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:CITRUS PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-599-6811
Mailing Address - Street 1:1420 S CENTRAL AVE
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2508
Mailing Address - Country:US
Mailing Address - Phone:818-502-2321
Mailing Address - Fax:818-409-7708
Practice Address - Street 1:1420 S CENTRAL AVE
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2508
Practice Address - Country:US
Practice Address - Phone:818-502-2321
Practice Address - Fax:818-409-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0013380Medicaid
CAGR0013382Medicaid
CAGR0013381Medicaid
CAGR0013382Medicaid
CAHW2715Medicare PIN