Healthcare Provider Details

I. General information

NPI: 1962492264
Provider Name (Legal Business Name): JAMES FIORENTINO P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 PLEASANT ST SUITE 202
FALL RIVER MA
02721-3005
US

IV. Provider business mailing address

289 PLEASANT ST SUITE 202
FALL RIVER MA
02721-3005
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-2503
  • Fax: 508-646-7641
Mailing address:
  • Phone: 508-678-2503
  • Fax: 508-646-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number494
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN154375
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00055
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: