Organization
HISTOPATHOLOGY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHODADAD MEHRAEIN MD (PRESIDENT/CEO)
(949) 415-2535
Entity
Organization
Contact information
Practice address
15012 RED HILL AVE, SUITE 8H, TUSTIN, CA 92780-6524
(949) 415-2535
Mailing address
15012 RED HILL AVENUE, SUITE 8H, TUSTIN, CA 92780
(949) 415-2535
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2009046
CLIA
CA
01
—
339775
CLF
CA
Enumeration date
10/15/2010
Last updated
10/22/2014
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