Organization
PATHSYNERGY
Active
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
Update your record
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