Healthcare Provider Details

I. General information

NPI: 1477582161
Provider Name (Legal Business Name): CALIFORNIA PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W LAS POSITAS BLVD
PLEASANTON CA
94588-4000
US

IV. Provider business mailing address

3116 W MARCH LN STE 200
STOCKTON CA
95219-2370
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-6555
  • Fax: 209-473-6544
Mailing address:
  • Phone: 209-473-6555
  • Fax: 209-473-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ENFIELD
Title or Position: MANAGING PARTNER
Credential:
Phone: 209-473-6555