Organization
AFFILIATED PATHOLOGISTS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANETTE KENNEBREW (ADMINISTRATOR)
(310) 225-3221
Entity
Organization
Contact information
Practice address
20001 S RANCHO WAY, RANCHO DOMINGUEZ, CA 90220-6318
(310) 225-3221
(310) 698-7040
Mailing address
20001 S RANCHO WAY, RANCHO DOMINGUEZ, CA 90220-6318
(310) 225-3221
(310) 698-7040
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017680
—
CA
05
—
GR0023280
—
CA
05
—
GR0054410
—
CA
05
—
GR0055010
—
CA
05
—
GR0076820
—
CA
05
—
GR0082250
—
CA
05
—
GR0085330
—
CA
05
—
GR0085333
—
CA
05
—
GR0085336
—
CA
05
—
GR0085337
—
CA
Enumeration date
07/04/2006
Last updated
03/14/2025
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