Organization
YOSEMITE PATHOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT COLLETTI MHA (CHIEF OPERATING OFFICER)
(209) 577-1200
Entity
Organization
Contact information
Practice address
768 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9707
(209) 577-1200
(209) 577-6517
Mailing address
PO BOX 576768, MODESTO, CA 95357-6768
(209) 577-1200
(209) 577-6517
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
A24567
CA
291U00000X
Clinical Medical Laboratory
G27612
CA
291U00000X
Clinical Medical Laboratory
Primary
G37943
CA
291U00000X
Clinical Medical Laboratory
G66626
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017748
—
CA
Enumeration date
04/29/2008
Last updated
04/29/2008
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