# PATHOLOGY MEDICAL GROUP OF SAINT JOHN'S

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

## Provider details

- **NPI number:** 1417992868
- **Authorized official:** DAVID L KRASNE MD (MANAGING PARTNER)
- **Authorized official phone:** (310) 829-8101

## Contact information

- **Practice address:** 1328 22ND ST, PATHOLOGY DEPT, SANTA MONICA, CA 90404-2032
- **Practice address phone:** (310) 829-8101
- **Practice address fax:** (310) 829-6509
- **Mailing address:** 1328 22ND ST, PATHOLOGY DEPT, SANTA MONICA, CA 90404-2032
- **Mailing address phone:** (310) 829-8101
- **Mailing address fax:** (310) 829-6509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | G58882 | CA | Yes |

## Other

- **Enumeration date:** 06/19/2006
- **Last updated:** 10/04/2007