MEDICARE: YOSEMITE PATHOLOGY MEDICAL GROUP, INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0500X	Cytopathology Physician	C32684	CA
2	207ZD0900X	Dermatopathology (Pathology) Physician	C32684	CA
3	207ZF0201X	Forensic Pathology Physician	C32684	CA
4	207ZI0100X	Immunopathology Physician	C32684	CA
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	C32684	CA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CP5083	OTHER	CA	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690005510	OTHER	CA	RAILROAD LAB
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1598760985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOSEMITE PATHOLOGY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	PO BOX 576768
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95357-6768
Country	:	US
Telephone Number	:	209-577-1200
Fax Number	:	209-577-6517

Provider Business Practice Location Address
First Line	:	4301 N STAR WAY
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-9262
Country	:	US
Telephone Number	:	209-577-1200
Fax Number	:	209-577-6517

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	JENNIFER PINASCO
Credential	:
Telephone Number	:	209-577-1200

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/09/2024