Basic Information
| Provider Information | |||||||||
| NPI: | 1396161014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONTRA COSTA PATHOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1440 | ||||||||
| Address2: | |||||||||
| City: | SUISUN CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109640458 | ||||||||
| FaxNumber: | 5109640476 | ||||||||
| Practice Location | |||||||||
| Address1: | 399 TAYLOR BLVD SW 200 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252703575 | ||||||||
| FaxNumber: | 9252703589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2014 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | LATNER | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9252703575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZD0900X | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
No ID Information.