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General NPI Number Information
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NPI Number | 1649546300
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Entity Type | Individual
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Provider Name | MR. CLINTON PAUL PINA III
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Gender | Male
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 503 ROCKDALE AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1460
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Country | US
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Telephone | 508-951-6732
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Fax |
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Provider Business Mailing Address
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Address Line | 503 ROCKDALE AVE
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City | NEW BEDFORD
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State | MA
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Zip | 02740-1460
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Country | US
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Telephone | 508-951-6732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 322D00000X
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License Number State | MA
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