Healthcare Provider Details

I. General information

NPI: 1902127855
Provider Name (Legal Business Name): CHRISTOPHER PINNAVAIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N WILSON WAY
STOCKTON CA
95205-3119
US

IV. Provider business mailing address

105 S SAN JOAQUIN ST
STOCKTON CA
95202-3206
US

V. Phone/Fax

Practice location:
  • Phone: 209-948-2199
  • Fax:
Mailing address:
  • Phone: 209-481-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: