Healthcare Provider Details

I. General information

NPI: 1336664796
Provider Name (Legal Business Name): M LORRAINE PURINO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 W HUNTINGTON DR STE 309
ARCADIA CA
91007-3495
US

IV. Provider business mailing address

289 W HUNTINGTON DR STE 309
ARCADIA CA
91007-3495
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-8481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. M LORRAINE PURINO
Title or Position: OWNER
Credential: MD
Phone: 626-445-8481