1134182264 NPI number — CHARISMA O PINNA M.D.

Table of content: CHARISMA O PINNA M.D. (NPI 1134182264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134182264 NPI number — CHARISMA O PINNA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINNA
Provider First Name:
CHARISMA
Provider Middle Name:
O
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1134182264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 S 300 E
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-688-8413
Provider Business Mailing Address Fax Number:
435-673-4045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 S 300 E
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-688-8413
Provider Business Practice Location Address Fax Number:
435-673-4045
Provider Enumeration Date:
04/10/2006

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: 174400000X , with the licence number:  55256331205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 55256331200001 . This is a "BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 51216 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: P00275005 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 2300148 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 233290 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 7509310 . This is a "AETNA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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