Organization
PATHNET ESOTERIC LABORATORY INSTITUTE
Active
Parent organization
PATHNET ESOTERIC LABORATORY INSTITUTE
Other names
PathNet Laboratory Institute South
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATHNET ESOTERIC LABORATORY INSTITUTE
Authorized official
MR. ALAN MITCHELL KAYE (PRESIDENT/CEO)
(818) 780-6300
Entity
Organization
Contact information
Practice address
7247 HAYVENHURST AVE, SUITE A3, VAN NUYS, CA 91406-2871
(818) 780-6300
(818) 781-2243
Mailing address
7247 HAYVENHURST AVE, SUITE A3, VAN NUYS, CA 91406-2871
(818) 780-6300
(818) 781-2243
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF1123
CA
291U00000X
Clinical Medical Laboratory
COS800143
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0589010
IOWA MEDICAID
TX
01
—
0970533
IOWA MEDICAID
CA
05
—
1670200
—
TX
01
—
269558
OR MEDICAID
CA
01
—
269559
OR MEDICAID
TX
01
—
37000809
KY MEDICAID
TX
01
—
37903853
KY MEDICAID
CA
05
—
LAB17440F
—
CA
05
—
LB233CA
—
AL
Enumeration date
09/13/2006
Last updated
04/20/2008
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