Individual
JAY PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 E. VALENCIA MESA DRIVE, PATHOLOGY DEPT, FULLERTON, CA 92835
(714) 992-3907
(714) 992-3055
Mailing address
PO BOX 749421, LOS ANGELES, CA 90074-9421
(310) 225-3244
(310) 698-7054
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G42128
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G421280
—
CA
Enumeration date
06/19/2006
Last updated
02/06/2009
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