Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207ZB0001X | Pathology | Blood Banking & Transfusion Medicine | 05D0928654 | CALIFORNIA | No |
| 2 | 207ZC0500X | Pathology | Cytopathology | 05D0928654 | CALIFORNIA | No |
| 3 | 207ZD0900X | Pathology | Dermatopathology | 05D0928654 | CALIFORNIA | No |
| 4 | 207ZF0201X | Pathology | Forensic Pathology | 05D0928654 | CALIFORNIA | No |
| 5 | 207ZH0000X | Pathology | Hematology | 05D0928654 | CALIFORNIA | No |
| 6 | 207ZI0100X | Pathology | Immunopathology | 05D0928654 | CALIFORNIA | No |
| 7 | 207ZM0300X | Pathology | Medical Microbiology | 05D0928654 | CALIFORNIA | No |
| 8 | 207ZN0500X | Pathology | Neuropathology | 05D0928654 | CALIFORNIA | No |
| 9 | 207ZP0007X | Pathology | Molecular Genetic Pathology | 05D0928654 | CALIFORNIA | No |
| 10 | 207ZP0101X | Pathology | Anatomic Pathology | 05D0928654 | CALIFORNIA | No |
| 11 | 207ZP0104X | Pathology | Chemical Pathology | 05D0928654 | CALIFORNIA | No |
| 12 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | 05D0928654 | CALIFORNIA | No |
| 13 | 207ZP0213X | Pathology | Pediatric Pathology | 05D0928654 | CALIFORNIA | No |
| 14 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | 05D0928654 | CALIFORNIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 05D1065390 | OTHER | CALIFORNIA | CLIA NUMBER |
| 2 | GR0101421 | MEDICAID | CALIFORNIA | |
| 3 | CH7107 | OTHER | CALIFORNIA | RAILROAD MEDICARE |
| 4 | LAB28654F | MEDICAID | CALIFORNIA | |
| 5 | CG4848 | OTHER | CALIFORNIA | RAILROAD MEDICARE |
| 6 | 05D0939440 | OTHER | CALIFORNIA | CLIA NUMBER |
| 7 | 807975000 | MEDICAID | IDAHO | |
| 8 | HW7801B | MEDICARE ID-TYPE UNSPECIFIED | CALIFORNIA | MEDICARE ID NUMBER |
| 9 | LAB39440F | MEDICAID | CALIFORNIA | |
| 10 | CQ2142 | OTHER | CALIFORNIA | RAILROAD MEDICARE |
| 11 | 05D0928654 | OTHER | CALIFORNIA | CLIA ID NUMBER |
| 12 | 05D0058906 | OTHER | CALIFORNIA | CLIA |
| 13 | 05D0670053 | OTHER | CALIFORNIA | CLIA |
| 14 | W7801B | MEDICARE ID-TYPE UNSPECIFIED | CALIFORNIA | MEDICARE ID NUMBER |
| 15 | HW7801A | MEDICARE ID-TYPE UNSPECIFIED | CALIFORNIA | MEDICARE ID NUMBER |
| 16 | W7801 | MEDICARE PIN | CALIFORNIA | |
| 17 | GR0101420 | MEDICAID | CALIFORNIA | |
