Provider Demographics
NPI:1356662209
Name:PRECISION PATHOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PRECISION PATHOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-577-1200
Mailing Address - Street 1:PO BOX 576730
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6730
Mailing Address - Country:US
Mailing Address - Phone:209-577-1200
Mailing Address - Fax:209-577-6517
Practice Address - Street 1:6001 NORRIS CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5400
Practice Address - Country:US
Practice Address - Phone:925-275-8408
Practice Address - Fax:925-275-8362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOSEMITE PATHOLOGY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-15
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEX141AMedicare PIN