1629656921 NPI number — MRS. MARISA CHERYL PINTO MD

Table of content: LUKE MICHAEL BRUNER (NPI 1104617505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629656921 NPI number — MRS. MARISA CHERYL PINTO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINTO
Provider First Name:
MARISA
Provider Middle Name:
CHERYL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629656921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
733 5TH ST APT 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95605-2677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-250-5028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11670 ATWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95603-9522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-887-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2021

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: 207Q00000X , with the licence number:  A186652 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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