Organization
MAGNOLIA PATHOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE ODELL M.D. (PRESIDENT)
(951) 352-5301
Entity
Organization
Contact information
Practice address
3865 JACKSON ST, DEPT OF PATHOLOGY, RIVERSIDE, CA 92503-3919
(951) 352-5301
(951) 352-5340
Mailing address
PO BOX 2245, RIVERSIDE, CA 92516-2245
(661) 705-3441
(951) 848-0999
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AW462A
MEDICARE PTAN
CA
01
—
DO4317
RAILROAD MEDICARE GROUP PTAN
—
Enumeration date
03/16/2006
Last updated
08/15/2019
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