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NPI Code Detail

MEDICARE: JUDY MARIE PINSONNEAULT D.O.

MEDICARE: JUDY MARIE PINSONNEAULT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianDO27753OR
2207Q00000XFamily Medicine Physician2762AZ

General Provider Information

NPI Number : 1184627648
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY MARIE PINSONNEAULT D.O.
Provider Business Mailing Address
First Line : PO BOX 31001-0698
Second Line :
City : PASADENA
State : CA
Zip : 91110-0698
Country : US
Telephone Number : 602-263-1200
Fax Number :
Provider Business Practice Location Address
First Line : 4212 N 16TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-5319
Country : US
Telephone Number : 602-263-1501
Fax Number : 602-263-1547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 05/03/2019

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