NPIMap

Organization Active NPI

Peninsula Pathologists Medical Group

  • Clinical Medical Laboratory
  • South San Francisco, CA
National Provider Identifier
1063662211
Registry record updated Sep 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
CLF331997 Issued in CA
Legal business name
PENINSULA PATHOLOGISTS MEDICAL GROUP
Practice address
393 E Grand Ave
Suite I
South San Francisco, CA 94080-6233
Phone
(650) 616-2955
Fax
(650) 246-3623
NPI assigned
Sep 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy Alonzo, MDNPI 1124040787
Title
President
Phone
(650) 616-2955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X CLF331997 CA Primary

Addresses

Primary practice location

393 E Grand Ave
Suite I
South San Francisco, CA 94080-6233

Mailing address

393 E Grand Ave
Suite I
South San Francisco, CA 94080-6233
Phone (650) 616-2955

National Provider Directory

National Provider Directory

Locations

77 Birch St
Redwood City, CA 94062
Phone (650) 616-2951

393 E Grand Ave
Ste I
South San Francisco, CA 94080
Phone (650) 589-5278

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222214400000",
    "number": "1063662211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E GRAND AVE",
            "address_2": "SUITE I",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940806233",
            "telephone_number": "650-616-2955",
            "fax_number": "650-246-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 E GRAND AVE",
            "address_2": "SUITE I",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940806233",
            "telephone_number": "650-616-2955",
            "fax_number": "650-246-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PATHOLOGISTS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-24",
        "last_updated": "2008-09-24",
        "status": "A",
        "authorized_official_last_name": "ALONZO",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "650-616-2955",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF331997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.