Healthcare Provider Details

I. General information

NPI: 1881294148
Provider Name (Legal Business Name): EMMANUEL PINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GRANT ST
FRAMINGHAM MA
01702-6764
US

IV. Provider business mailing address

14B MUGGETT HILL RD
CHARLTON MA
01507-1322
US

V. Phone/Fax

Practice location:
  • Phone: 508-834-3100
  • Fax:
Mailing address:
  • Phone: 774-364-2115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2333665
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: