Provider Demographics
NPI:1306814918
Name:DELTA PATHOLOGY ASSOCIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:DELTA PATHOLOGY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-477-4432
Mailing Address - Street 1:PO BOX 77800
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-1100
Mailing Address - Country:US
Mailing Address - Phone:209-477-4432
Mailing Address - Fax:209-320-6136
Practice Address - Street 1:3133 W MARCH LN
Practice Address - Street 2:SUITE 1040
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2336
Practice Address - Country:US
Practice Address - Phone:209-477-4432
Practice Address - Fax:209-320-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0609388207ZB0001X, 207ZP0104X, 207ZM0300X, 207ZN0500X, 207ZP0102X, 207ZP0105X, 207ZC0500X, 207ZD0900X, 207ZH0000X, 207ZI0100X, 207ZP0213X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical PathologyGroup - Single Specialty
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Single Specialty
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Single Specialty
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathologyGroup - Single Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA220010681OtherRAILROAD MEDICARE
CALAB09388FMedicaid
CALAB09388FMedicaid