Provider Demographics
NPI:1104856574
Name:PINNER, ANTHONY MAURICE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MAURICE
Last Name:PINNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MAGNOLIA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3330
Mailing Address - Country:US
Mailing Address - Phone:951-735-9211
Mailing Address - Fax:
Practice Address - Street 1:341 MAGNOLIA AVE
Practice Address - Street 2:STE 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3330
Practice Address - Country:US
Practice Address - Phone:951-735-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16717363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP82503Medicare UPIN