Organization
OC PATH MEDICAL GROUP
Active
Other names
ORANGE REGIONAL PATHOLOGY ASSOCIATES INC
Organization subpart
No
Provider details
NPI number
Authorized official
JON P LAKE MD (PRESIDENT)
(714) 827-6701
Entity
Organization
Contact information
Practice address
14662 NEWPORT AVE, TUSTIN, CA 92780-6064
(714) 669-2000
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-3911
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
05D0935646
CA
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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