Provider Demographics
NPI:1679808315
Name:SUMMIT PATHOLOGY LABORATORIES INC
Entity type:Organization
Organization Name:SUMMIT PATHOLOGY LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-385-5711
Mailing Address - Street 1:14431 VENTURA BLVD
Mailing Address - Street 2:SUITE 608
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2606
Mailing Address - Country:US
Mailing Address - Phone:818-385-5711
Mailing Address - Fax:
Practice Address - Street 1:14431 VENTURA BLVD
Practice Address - Street 2:SUITE 608
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2606
Practice Address - Country:US
Practice Address - Phone:818-385-5711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty