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General NPI Number Information
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NPI Number | 1598760985
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Entity Type | Organization
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Legal Business Name | YOSEMITE PATHOLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 4301 N STAR WAY
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City | MODESTO
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State | CA
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Zip | 95356-9262
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Country | US
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Telephone | 209-577-1200
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Fax | 209-577-6517
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Provider Business Mailing Address
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Address Line | PO BOX 576768
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City | MODESTO
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State | CA
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Zip | 95357-6768
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Country | US
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Telephone | 209-577-1200
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Fax | 209-577-6517
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | JENNIFER PINASCO
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Credential |
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Telephone | 209-577-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | C32684
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | C32684
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207ZF0201X
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Taxonomy Name | Forensic Pathology Physician
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License Number | C32684
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207ZI0100X
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Taxonomy Name | Immunopathology Physician
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License Number | C32684
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | C32684
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License Number State | CA
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