MEDICARE: DR. ASUNCION PURISIMA DISINI M.D.

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
1	208000000X	Pediatrics Physician	C39875	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D61827	OTHER	CA	MEDI-CAL UPIN

General Provider Information

NPI Number	:	1508100769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASUNCION PURISIMA DISINI M.D.

Provider Business Mailing Address
First Line	:	1057 WOODVIEW PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-3233
Country	:	US
Telephone Number	:	408-268-8027
Fax Number	:

Provider Business Practice Location Address
First Line	:	1057 WOODVIEW PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-3233
Country	:	US
Telephone Number	:	408-268-8027
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2012
Last Update Date	:	11/11/2012

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