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General NPI Number Information
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NPI Number | 1992857718
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Entity Type | Organization
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Legal Business Name | STEPHEN PINSK, M.D., INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 2449 SUMMERFIELD RD
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City | SANTA ROSA
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State | CA
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Zip | 95405-7815
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Country | US
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Telephone | 707-829-5883
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Fax | 707-829-5895
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Provider Business Mailing Address
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Address Line | PO BOX 1676
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City | SEBASTOPOL
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State | CA
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Zip | 95473-1676
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Country | US
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Telephone | 707-829-5883
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Fax | 707-829-5895
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVE C. MERTENS
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Credential | M.D.
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Telephone | 707-829-5883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF382
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License Number State | CA
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