Healthcare Provider Details

I. General information

NPI: 1457437253
Provider Name (Legal Business Name): MARIO DE PINTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 POST ST
SAN FRANCISCO CA
94115-3427
US

IV. Provider business mailing address

2 SAINT JUDE RD
MILL VALLEY CA
94941-1747
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7246
  • Fax:
Mailing address:
  • Phone: 206-335-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC55902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: