Organization
ORANGE REGIONAL PATHOLOGY ASSOCIATES
Active
Other names
OC PATH MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
JON P LAKE MD (PRESIDENT)
(323) 730-7371
Entity
Organization
Contact information
Practice address
2231 S WESTERN AVE, LOS ANGELES, CA 90018-1302
(323) 730-7371
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-3911
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
05D0058772
CA
Other
Enumeration date
08/03/2012
Last updated
08/03/2012
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