Healthcare Provider Details

I. General information

NPI: 1073760906
Provider Name (Legal Business Name): MARCOS DI PINTO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE SUITE 503
ORANGE CA
92868-4213
US

IV. Provider business mailing address

1201 W LA VETA AVE SUITE 503
ORANGE CA
92868-4213
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-4385
  • Fax:
Mailing address:
  • Phone: 714-516-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2753
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: