Mammoth Path Solution LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MAMMOTH PATH SOLUTION LLC

Practice address

20505 Crescent Bay Dr Ste A2
Lake Forest, CA 92630-8825

Phone

(949) 317-0345

Fax

(949) 446-9141

NPI assigned

Nov 21, 2023

Organization subpart

No

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

Authorized official

Name

Ryan Hilton

Title

Owner

Phone

(305) 332-0669

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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

{
    "created_epoch": "1700524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1790550523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20505 CRESCENT BAY DR",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308825",
            "telephone_number": "949-317-0345",
            "fax_number": "949-446-9141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20505 CRESCENT BAY DR STE A2",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308825",
            "telephone_number": "949-317-0345",
            "fax_number": "949-446-9141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAMMOTH PATH SOLUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-21",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "HILTON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-332-0669"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Majowicz, FNP-BC
• Alya Makarem
• Celeste Maldonado
• Gregg S Mallett, DC, ATC, CKTP
• Elena Malone
• Mammoth Path Solution, LLC
• Katty Mirella Mancia, OTR/L
• Elizabeth Elaine Mann
• Christian Oliver Manrubia
• Abbyella Mao

• Clinical Medical Laboratory in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.