Basic Information
| Provider Information | |||||||||
| NPI: | 1972768844 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIGNONE | ||||||||
| FirstName: | MARIAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6410 1/2 W OLYMPIC BLVD | ||||||||
| Address2: | 4560 ADMIRAL WAY, SUITE 303, MARINA DEL REY, CA 9002 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239353270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12756 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188960531 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 07/21/2008 | ||||||||
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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 | 363AM0700X | 51158 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.