MEDICARE: MR. ANTHONY PINATELLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1639651623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY PINATELLI

Provider Business Mailing Address
First Line	:	500 RACQUET WAY
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9490
Country	:	US
Telephone Number	:	707-695-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 RACQUET WAY
Second Line	:
City	:	DIAMOND SPRINGS
State	:	CA
Zip	:	95619-9490
Country	:	US
Telephone Number	:	707-695-2054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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Directions to “ MR. ANTHONY PINATELLI ” Practice Location

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