Provider Demographics
NPI:1376062141
Name:UNIVERSITY DERMATOPATHOLOGY SERVICES INC
Entity type:Organization
Organization Name:UNIVERSITY DERMATOPATHOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-998-0976
Mailing Address - Street 1:PO BOX 847258
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-3565
Mailing Address - Country:US
Mailing Address - Phone:650-815-2120
Mailing Address - Fax:
Practice Address - Street 1:2220 N SCREENLAND DR STE 101
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1137
Practice Address - Country:US
Practice Address - Phone:954-998-0976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73000207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty