Basic Information
| Provider Information | |||||||||
| NPI: | 1922114362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACINAS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | DIANA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12775 FAIR WAY | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950765459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317222201 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 950 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939052150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317576237 | ||||||||
| FaxNumber: | 8317578458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G66785 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G667850 | 05 | CA | MEDICAID |