Organization
PENINSULA PATHOLOGISTS MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDY A ALONZO M.D. (PRESIDENT)
(650) 616-2950
Entity
Organization
Contact information
Practice address
1783 EL CAMINO REAL, PATHOLOGY DEPT, BURLINGAME, CA 94010-3205
(650) 696-5611
Mailing address
383 E GRAND AVE, SUITE A, SOUTH SAN FRANCISCO, CA 94080-6234
(650) 616-2951
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
CLF331997
CA
207ZC0500X
Cytopathology Physician
CLF331997
CA
207ZD0900X
Dermatopathology (Pathology) Physician
CLF331997
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0030570
—
CA
05
—
GR0030572
—
CA
05
—
GR0030573
—
CA
05
—
GR0030575
—
CA
05
—
LAB27269F
—
CA
Enumeration date
04/18/2006
Last updated
10/16/2007
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