Organization
YOSEMITE PATHOLOGY MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PINASCO (DELEGATED OFFICIAL)
(209) 577-1200
Entity
Organization
Contact information
Practice address
4301 N STAR WAY, MODESTO, CA 95356-9262
(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
207ZC0500X
Cytopathology Physician
C32684
CA
207ZD0900X
Dermatopathology (Pathology) Physician
C32684
CA
207ZF0201X
Forensic Pathology Physician
C32684
CA
207ZI0100X
Immunopathology Physician
C32684
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
C32684
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690005510
RAILROAD LAB
CA
01
—
CP5083
RAILROAD MEDICARE
CA
05
—
GR0017740
—
CA
05
—
GR0017741
—
CA
05
—
GR0017742
—
CA
05
—
GR0017744
—
CA
05
—
GR0017745
—
CA
05
—
GR0017748
—
CA
05
—
GR001774A
—
CA
Enumeration date
06/14/2005
Last updated
09/09/2024
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