# HIGH DESERT PATHOLOGY MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407191356
- **Authorized official:** REDA M TADROS MD (PRESIDENT)
- **Authorized official phone:** (760) 843-6262

## Contact information

- **Practice address:** 16850 BEAR VALLEY RD, VICTORVILLE, CA 92395-5794
- **Practice address phone:** (760) 843-6262
- **Mailing address:** PO BOX 10076, VAN NUYS, CA 91410-0076
- **Mailing address phone:** (805) 578-8300
- **Mailing address fax:** (805) 578-3911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 05D0562204 | CA | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 05D0563949 | CA | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 05D0643174 | CA | Yes |

## Other

- **Enumeration date:** 12/04/2012
- **Last updated:** 12/04/2012