Organization
PACIFIC PATHOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLARD FRANK WORTHEN II MD (PRESIDENT)
(310) 680-8391
Entity
Organization
Contact information
Practice address
555 E HARDY ST, PATHOLOGY DEPARTMENT, INGLEWOOD, CA 90301
(310) 680-8391
(310) 412-4501
Mailing address
555 E HARDY ST, DEPARTMENT OF PATHOLOGY, INGLEWOOD, CA 90301
(310) 680-8391
(310) 412-4501
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0045860
—
CA
05
—
GR0045861
—
CA
Enumeration date
11/01/2006
Last updated
08/22/2020
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