Organization
HIGH DESERT PATHOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REDA M TADROS MD (PRESIDENT)
(760) 843-6262
Entity
Organization
Contact information
Practice address
16850 BEAR VALLEY RD, VICTORVILLE, CA 92395-5794
(760) 843-6262
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
05D0562204
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
05D0563949
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
05D0643174
CA
Other
Enumeration date
12/04/2012
Last updated
12/04/2012
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