Organization
UNIVERSITY OF THE PACIFIC
Active
Parent organization
UNIVERSITY OF THE PACIFIC
Other names
Pacific Oral & Maxillofacial Pathology Laboratory, Pacific Oral & Maxillofacial Pathology Laboratory, Arthur A. Dugoni School of Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF THE PACIFIC
Authorized official
MR. ED PEGUEROS (ASST DEAN, BUDGET & FIN ADMIN)
(415) 351-7192
Entity
Organization
Contact information
Practice address
155 5TH ST, POPL SUITE 407E, SAN FRANCISCO, CA 94103-2919
(415) 929-6560
(415) 929-6654
Mailing address
155 5TH ST, POPL SUITE 407E, SAN FRANCISCO, CA 94103-2919
(415) 929-6560
(415) 929-6654
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0643664
CLIA NUMBER
CA
01
—
CLF 00002594
STATE ID NUMBER
CA
Enumeration date
03/18/2014
Last updated
07/22/2020
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