Healthcare Provider Details

I. General information

NPI: 1962692699
Provider Name (Legal Business Name): JILL PAGNI PARELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL ANGELA PAGNI MD

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 08/20/2023
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 POST OFFICE DR STE F
APTOS CA
95003-3953
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-612-6264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37310
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA100311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: