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
350 S OAK AVE, OAKDALE, CA 95361-3519
(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
Primary
G27523
CA
291U00000X
Clinical Medical Laboratory
G27612
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017744
—
CA
Enumeration date
04/29/2008
Last updated
04/29/2008
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