Oc Path Medical Group

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

05D0582538 Issued in CA

Legal business name

OC PATH MEDICAL GROUP

Doing business as

Orange Regional Pathology Associate

Practice address

3350 W Ball Rd
Anaheim, CA 92804-3710

Phone

(714) 827-6701

NPI assigned

Jan 7, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jon P Lake, MD

Title

President

Phone

(714) 633-0011

Specialties & licenses 2

Addresses

Other names 1

• ORANGE REGIONAL PATHOLOGY ASSOCIATE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1235469685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10076",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914100076",
            "telephone_number": "805-578-8300",
            "fax_number": "805-578-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 W BALL RD",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043710",
            "telephone_number": "714-827-6701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OC PATH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "LAKE",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-633-0011",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": "CA",
            "license": "05D0582538",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "05D0582538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORANGE REGIONAL PATHOLOGY ASSOCIATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Anatomic Pathology & Clinical Pathology Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.