Healthcare Provider Details

I. General information

NPI: 1902402860
Provider Name (Legal Business Name): JULIA R PINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT ST MEMORIAL BUILDING, WEST, FLOOR 2
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT ST. MEMORIAL BUILDING, WEST, FLOOR 2
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-4003
  • Fax: 603-227-7526
Mailing address:
  • Phone: 603-224-4003
  • Fax: 603-227-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1735
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: