Organization
YOSEMITE PATHOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT COLLETTI M.H.A. (CHIEF OPERATING OFFICER)
(209) 577-1200
Entity
Organization
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
(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
A72455
CA
291U00000X
Clinical Medical Laboratory
A83286
CA
291U00000X
Clinical Medical Laboratory
Primary
G25623
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017740
—
CA
Enumeration date
04/28/2008
Last updated
04/28/2008
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