Provider Demographics
NPI:1912991597
Name:PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESTEBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-847-6052
Mailing Address - Street 1:2219 W OLIVE AVE # 219
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2625
Mailing Address - Country:US
Mailing Address - Phone:818-847-6052
Mailing Address - Fax:323-784-2904
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-847-6052
Practice Address - Fax:818-847-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0011010Medicaid
CAHW7636Medicare PIN