Provider Demographics
NPI:1841535044
Name:SPECIALIZED PATHOLOGY LABORATORIES, LLC
Entity type:Organization
Organization Name:SPECIALIZED PATHOLOGY LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDIAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-404-2371
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:ATWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92811-0888
Mailing Address - Country:US
Mailing Address - Phone:714-404-2371
Mailing Address - Fax:
Practice Address - Street 1:17451 BASTANCHURY RD
Practice Address - Street 2:SUITE 204-30
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1857
Practice Address - Country:US
Practice Address - Phone:714-577-0413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF342821291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory