# OC PATH MEDICAL GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** ORANGE REGIONAL PATHOLOGY ASSOCIATES INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700171501
- **Authorized official:** JON P LAKE MD (PRESIDENT)
- **Authorized official phone:** (714) 827-6701

## Contact information

- **Practice address:** 14662 NEWPORT AVE, TUSTIN, CA 92780-6064
- **Practice address phone:** (714) 669-2000
- **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 | 05D0935646 | CA | Yes |

## Other

- **Enumeration date:** 06/09/2011
- **Last updated:** 06/09/2011