Provider Demographics
NPI:1598760985
Name:YOSEMITE PATHOLOGY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:YOSEMITE PATHOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PINASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-577-1200
Mailing Address - Street 1:PO BOX 576768
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6768
Mailing Address - Country:US
Mailing Address - Phone:209-577-1200
Mailing Address - Fax:209-577-6517
Practice Address - Street 1:4301 N STAR WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9262
Practice Address - Country:US
Practice Address - Phone:209-577-1200
Practice Address - Fax:209-577-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32684207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZI0100X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA690005510OtherRAILROAD LAB
CACP5083OtherRAILROAD MEDICARE
CAGR0017740Medicaid
CAGR0017745Medicaid
CAGR0017742Medicaid
CAGR001774AMedicaid
CAGR0017741Medicaid
CAGR0017748Medicaid
CAGR0017744Medicaid
CAGR0017740Medicaid
CA690005510OtherRAILROAD LAB
CAZZZ13320ZMedicare ID - Type UnspecifiedSTH
CAGR0017741Medicaid
CAZZZ94361ZMedicare ID - Type UnspecifiedDMC
CAZZZ93347ZMedicare ID - Type UnspecifiedOV
CAZZZ93345ZMedicare ID - Type UnspecifiedMHA
CAZZZ93344ZMedicare ID - Type UnspecifiedTGH
CAZZZ97403ZMedicare ID - Type UnspecifiedMT
CAGR001774AMedicaid
CAGR0017742Medicaid