Doctor Name: | DR. MARIO L PINOLI |
NPI Number: | 1114156874 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | BP10034667 |
Business Practice Address: | 3615 19th St Lubbock, TX - 794101203 |
Business Phone Number: | 8067254479 |
Business Fax Number: | 8067250053 |
Mailing Address: | 3420 22nd Pl, LUBBOCK |
State: | TX |
Postal Code: | 794101314 |
Phone Number: | 8067255844 |
Fax Number: | 8067236532 |
NPI Enumeration Date: | 07/02/2009 |
NPI Last Update Date: | 07/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | BP10034667 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |