Basic Information
| Provider Information | |||||||||
| NPI: | 1053507442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN CALIFORNIA UROPATHOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 B ST | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157348726 | ||||||||
| FaxNumber: | 4157624220 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 B ST | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949013026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157348726 | ||||||||
| FaxNumber: | 4157624220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2007 | ||||||||
| LastUpdateDate: | 09/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4157348726 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | A98379 | CA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.