Healthcare Provider Details

I. General information

NPI: 1508560368
Provider Name (Legal Business Name): MALIA PINAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CATHERINE LN STE B
GRASS VALLEY CA
95945-5719
US

IV. Provider business mailing address

15094 STORMS LN
GRASS VALLEY CA
95945-7905
US

V. Phone/Fax

Practice location:
  • Phone: 530-271-2100
  • Fax:
Mailing address:
  • Phone: 619-751-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: