1033547419 NPI number — TIFFANY PINALES PA-C

Table of content: TIFFANY PINALES PA-C (NPI 1033547419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033547419 NPI number — TIFFANY PINALES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINALES
Provider First Name:
TIFFANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033547419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1785 NORTHPOINTE PKWY, SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUTZ
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33558-5742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-536-7277
Provider Business Mailing Address Fax Number:
833-642-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N WARE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-8055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-668-0044
Provider Business Practice Location Address Fax Number:
956-687-9747
Provider Enumeration Date:
10/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA09279 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107763801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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