Organization
PATHOLOGY MEDICAL GROUP OF SAINT JOHN'S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID L KRASNE MD (MANAGING PARTNER)
(310) 829-8101
Entity
Organization
Contact information
Practice address
1328 22ND ST, PATHOLOGY DEPT, SANTA MONICA, CA 90404-2032
(310) 829-8101
(310) 829-6509
Mailing address
1328 22ND ST, PATHOLOGY DEPT, SANTA MONICA, CA 90404-2032
(310) 829-8101
(310) 829-6509
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G58882
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095430
—
CA
Enumeration date
06/19/2006
Last updated
10/04/2007
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