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Organization

PATHSYNERGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SEPI MAHOOTI M.D. (PRESIDENT & C.E.O)
(203) 506-7862
Entity
Organization

Contact information

Practice address
13922 MENNONITE PT, SAN DIEGO, CA 92129-3134
(203) 506-7862
Mailing address
13922 MENNONITE PT, SAN DIEGO, CA 92129-3134
(203) 506-7862

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 00345706
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05D2073518
CLIA
CA
01
CLF 00345706
STATE LICENSE
CA
Enumeration date
11/14/2014
Last updated
11/14/2014
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