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1104856574 NPI number — ANTHONY MAURICE PINNER P.A-C

NPI Number: 1104856574
Health Care Provider/Practitioner: ANTHONY MAURICE PINNER P.A-C

Information about “1104856574” NPI (ANTHONY MAURICE PINNER P.A-C) exists in 1104856574 in HTML format HTML  |  1104856574 in plain Text format TXT  |  1104856574 in PDF (Portable Document Format) PDF  |  1104856574 in an XML format XML  formats.

NPI Number : 1104856574 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104856574",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PINNER",
    "FirstName": "ANTHONY",
    "MiddleName": "MAURICE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "P.A-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 35380",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NV",
    "MailingAddressPostalCode": "89133-5380",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "702-579-3203",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "12488 CENTRAL AVE STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHINO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91710-2625",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-613-0100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/03/2006",
    "LastUpdateDate": "11/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "PA16717",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA16717",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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