THE PATHOLOGY GROUP, INC. (NPI# 1316196892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316196892 |
| Entity Type | Organization |
| Organization Name | THE PATHOLOGY GROUP, INC. |
| Other Organization Name | ST JUDE PATHOLOGY MEDICAL GROUP |
| Practice Address |
101 E Valencia Mesa Dr Fullerton CA 92835-3809 |
| Mailing Address |
File 749241 Los Angeles CA 90074-0001 |
| Practice Telephone | 7149923907 |
| Practice Fax Number | 7149923055 |
| Mailing Telephone | 7149923907 |
| Mailing Fax Number | 7149923055 |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2009-01-15 |
| Authorized Official Name | VICTOR W LEE (SECRETARY) |
| Authorized Official Telephone | 7149923907 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| St Jude Pathology Medical Group | Doing Business As Name - Organization |
| Street Address |
101 E VALENCIA MESA DR |
| City | FULLERTON |
| State | CA |
| Zip Code | 92835-3809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912989591 | Pei-jing Ma | Physician Assistant | 101 E Valencia Mesa Dr, Em Dept, Fullerton, CA 92835-3809 | 2005-11-18 |
| 1508493461 | Key Medical Rehab Inc. | Physical Medicine & Rehabilitation | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2020-03-23 |
| 1902439938 | Collin Michael Fuhrman | Physician Assistant | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2020-02-18 |
| 1427697762 | Ashley Jungkman | Dietitian, Registered | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2020-01-03 |
| 1720632136 | Ken Yu Ki Chan | Nurse Practitioner | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2019-07-25 |
| 1548812332 | Don R Miller | Pharmacist | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2019-07-11 |
| 1700445640 | Hanna Ro | Physician Assistant | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2019-06-12 |
| 1023674298 | Gwendolyn Nguyen | Physician Assistant | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2019-05-14 |
| 1073072963 | Daniel Benjamin Graviloni | Respiratory Therapist, Registered | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2019-03-19 |
| 1639655947 | Noli Veneracion | Physical Therapist | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2018-07-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538774302 | Natalie Baugh | Nutritionist | 333 W Bastanchury Rd 110, Fullerton, CA 92835 | 2020-09-09 |
| 1073127098 | Cecile Mae Sam | Physical Therapist | 2932 Clover Ct, Fullerton, CA 92835 | 2020-09-08 |
| 1861966087 | Kimson F Johnston | Marriage & Family Therapist | 1370 Brea Blvd Suite 210, Fullerton, CA 92835 | 2019-01-22 |
| 1134636327 | Michelle Harriman, Psychologist - A Professional Corporation | Psychologist | 1440 N Harbor Blvd Ste 808, Fullerton, CA 92835 | 2018-01-09 |
| 1659818631 | Jacqueline Rene Miller | Specialist/Technologist | 2610 Associated Rd, Apt A4, Fullerton, CA 92835 | 2017-01-27 |
| 1912361106 | John Nathaniel Alvarez | Psychiatry & Neurology | 401 E Imperial Highway, Fullerton, CA 92835 | 2016-04-13 |
| 1083075030 | Advance Recovery Solution, LLC | Substance Abuse Rehabilitation Facility | 3744 N Hermosa Pl, Fullerton, CA 92835 | 2016-03-17 |
| 1467817981 | Michele Ledesma | Physical Therapy Assistant | 2800 N. Harbor Blvd., Fullerton, CA 92835 | 2015-12-29 |
| 1467820571 | Jonghan Kang | Acupuncturist | 1321 N Harbor Blvd Ste 205, Fullerton, CA 92835 | 2015-09-04 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| Find all providers in zip 92835 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275588527 | Cynthia N. Miller | Pathology | 101 E. Valencia Mesa Drive, Fullerton, CA 92635 | 2006-05-24 |
| 1205889672 | Howard Friedberg | Pathology | 101 E Valencia Mesa Dr., Fullerton, CA 92635 | 2006-05-18 |
| 1255384905 | Shirin M. Farahmand | Pathology | 101 E. Valencia Mesa Dr., Fullerton, CA 92635 | 2006-05-17 |
| 1538112206 | John R. Craig | Pathology | 101 E. Valenica Mesa Drive, Fullerton, CA 92835 | 2006-05-17 |
| 1528402427 | Sandhya Mary John | Pathology | 101 E Valencia Mesa Dr, Fullerton, CA 92835 | 2013-04-22 |
| 1396037537 | Mark Boonyasampant | Pathology | 101 E Valencia Mesa Dr, Fullerton, CA 92835-3809 | 2011-05-06 |
| 1821033150 | Jay Packer | Pathology | 101 E. Valencia Mesa Drive, Pathology Dept, Fullerton, CA 92835 | 2006-06-19 |
| 1245273457 | Victor W. Lee | Pathology | 101 E. Valencia Mesa Dr., Fullerton, CA 92631 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063058170 | Paragon Diagnostics San Francisco | Pathology | 900 Hyde St Fl 1, San Francisco, CA 94109-4806 | 2019-11-24 |
| 1669034518 | Diagnostic Pathology Medical Group Inc | Pathology | 2801 K St Ste 235, Sacramento, CA 95816-5170 | 2019-07-01 |
| 1093277956 | Shajia Rahman Ansari | Pathology | 38558 Vancouver Cmn, Fremont, CA 94536-4056 | 2019-04-01 |
| 1831655158 | Rana Richeh | Pathology | 12 Spectrum Pointe Dr, Lake Forest, CA 92630-2242 | 2019-02-11 |
| 1710457510 | University of California Sfgh Medical Group | Pathology | 1001 Potrero Ave Rm 2m14, San Francisco, CA 94110-3518 | 2018-12-05 |
| 1770053233 | Samuel Jason Guzman | Pathology | 10026 Karmont Ave, South Gate, CA 90280-5417 | 2018-11-27 |
| 1144799750 | Penguin Medical Group, Inc | Pathology | 11 W Del Mar Blvd Ste 201, Pasadena, CA 91105-2593 | 2018-11-13 |
| 1023596731 | Uc San Diego, Pathology Dept | Pathology | East Campus Office Building, Medical Center Dr, San Diego, CA 92037 | 2018-08-03 |
| 1972080752 | Boris Shlopov Md Pathology Medical Corporation | Pathology | 800 S Main, Corona, CA 92882 | 2018-07-24 |
| 1902383920 | Ntr Resources, LLC | Pathology | 17433 Nordhoff, Northridge, CA 91325 | 2018-07-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.