Provider Demographics
NPI:1588691414
Name:CONSULTANTS FOR PATH & LAB MED INC, A MEDICAL GROUP
Entity type:Organization
Organization Name:CONSULTANTS FOR PATH & LAB MED INC, A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-423-6627
Mailing Address - Street 1:31255 CEDAR VALLEY DR
Mailing Address - Street 2:SUITE 324
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4014
Mailing Address - Country:US
Mailing Address - Phone:818-338-8103
Mailing Address - Fax:818-338-8119
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-6627
Practice Address - Fax:310-423-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC62183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN
CAHW8056Medicare ID - Type Unspecified