Provider Demographics
NPI:1881618288
Name:PACIFIC PATHOLOGY, INC.
Entity type:Organization
Organization Name:PACIFIC PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-576-9960
Mailing Address - Street 1:9292 CHESAPEAKE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1059
Mailing Address - Country:US
Mailing Address - Phone:858-576-9960
Mailing Address - Fax:858-576-6857
Practice Address - Street 1:9292 CHESAPEAKE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1059
Practice Address - Country:US
Practice Address - Phone:858-576-9960
Practice Address - Fax:858-576-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 10272291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055390Medicaid
CAX558873Medicare PIN