Healthcare Provider Details

I. General information

NPI: 1184709313
Provider Name (Legal Business Name): DIAGNOSTIC PATHOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 CAPITOL AVE
SACRAMENTO CA
95616-5616
US

IV. Provider business mailing address

3301 C ST #200E
SACRAMENTO CA
95816-3300
US

V. Phone/Fax

Practice location:
  • Phone: 916-447-6267
  • Fax: 916-456-5842
Mailing address:
  • Phone: 916-447-6267
  • Fax: 916-447-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MICHAEL J FINN
Title or Position: CEO
Credential:
Phone: 916-446-0424