Organization
OC PATH MEDICAL GROUP ORANGE REGIONAL PATHOLOGY ASSOCIATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON P LAKE MD (PRESIDENT)
(714) 741-2765
Entity
Organization
Contact information
Practice address
1301 N ROSE DR, PLACENTIA, CA 92870-3802
(714) 524-4842
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103830
—
CA
Enumeration date
09/20/2006
Last updated
07/29/2008
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