Healthcare Provider Details

I. General information

NPI: 1164509337
Provider Name (Legal Business Name): CALIFORNIA PACIFIC PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4403
US

IV. Provider business mailing address

PO BOX 26060
FRESNO CA
93729-6060
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-6574
  • Fax: 415-641-6717
Mailing address:
  • Phone: 415-600-2200
  • Fax: 415-750-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN C MORETTO
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 415-641-6574