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General NPI Number Information
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NPI Number | 1942475900
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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 | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 350 S OAK AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3519
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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 | CHIEF OPERATING OFFICER
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Name | ROBERT COLLETTI
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Credential | MHA
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | G27612
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | G27523
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License Number State | CA
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