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General NPI Number Information
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NPI Number | 1477582161
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Entity Type | Organization
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Legal Business Name | CALIFORNIA PATHOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5555 W LAS POSITAS BLVD
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City | PLEASANTON
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State | CA
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Zip | 94588-4000
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Country | US
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Telephone | 209-473-6555
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Fax | 209-473-6544
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Provider Business Mailing Address
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Address Line | 3116 W MARCH LN STE 200
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City | STOCKTON
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State | CA
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Zip | 95219-2370
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Country | US
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Telephone | 209-473-6555
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Fax | 209-473-6544
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DAVID ENFIELD
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Credential |
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Telephone | 209-473-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number |
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License Number State |
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