Organization
SAN DIEGO PATHOLOGISTS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA STAYBOLDT M.D. (PRESIDENT)
(800) 288-8325
Entity
Organization
Contact information
Practice address
7592 METROPOLITAN DR, SUITE 405-407, SAN DIEGO, CA 92108-4428
(619) 297-4900
(619) 297-5460
Mailing address
7592 METROPOLITAN DR STE 405, SAN DIEGO, CA 92108-4428
(619) 325-8726
(619) 325-8728
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZD0900X
Dermatopathology (Pathology) Physician
—
—
207ZH0000X
Hematology (Pathology) Physician
—
—
207ZI0100X
Immunopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ57609Z
BLUE SHIELD GROUP NUMBER
CA
05
—
ZZZ81205Z
—
CA
Enumeration date
07/31/2006
Last updated
01/06/2026
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