West Coast Pathology Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 4407 Issued in CA

Legal business name

WEST COAST PATHOLOGY LABORATORY INC

Practice address

712 Alfred Nobel Dr
Hercules, CA 94547-1805

Phone

(510) 662-5200

NPI assigned

Jun 21, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Christine Hill

Title

Director of Operations

Phone

(510) 662-5200

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468972800000",
    "number": "1790781110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 ALFRED NOBEL DR",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471805",
            "telephone_number": "510-662-5214",
            "fax_number": "510-662-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 ALFRED NOBEL DR",
            "city": "HERCULES",
            "state": "CA",
            "postal_code": "945471805",
            "telephone_number": "510-662-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COAST PATHOLOGY LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2016-07-20",
        "status": "A",
        "authorized_official_last_name": "HILL",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "510-662-5200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 4407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB58423F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Laith Anwar Yacoub, R.PH

• Clinical Medical Laboratory in Hercules, CA
• Providers in Hercules, 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 Jul 20, 2016; 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.