Basic Information
| Provider Information | |||||||||
| NPI: | 1710300504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA PACIFIC PATHOLOGY MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26060 | ||||||||
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| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937296060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594554031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5176 HILL RD E | ||||||||
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| City: | LAKEPORT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954536300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072625000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | MORETTO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4156002200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.