Provider Demographics
NPI:1235147562
Name:PARDINI, AARON W (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:W
Last Name:PARDINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DR STE 411
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1724
Practice Address - Country:US
Practice Address - Phone:831-475-8834
Practice Address - Fax:831-462-2058
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26799207R00000X, 207RE0101X
CAC55620207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240156Medicaid
OR240156Medicaid
ORR135141Medicare PIN
ORRR PTAN P00357541Medicare PIN