Provider Demographics
NPI:1447836788
Name:OCEANA PATHOLOGY, INC.
Entity type:Organization
Organization Name:OCEANA PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:MOHAMMMAD
Authorized Official - Last Name:MAZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-306-5115
Mailing Address - Street 1:29 PRAIRIE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8840
Mailing Address - Country:US
Mailing Address - Phone:949-306-5115
Mailing Address - Fax:
Practice Address - Street 1:26501 RANCHO PKWY S STE 103
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8359
Practice Address - Country:US
Practice Address - Phone:949-306-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Single Specialty