Provider Demographics
NPI:1437158136
Name:HINO, STANLEY T (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:T
Last Name:HINO
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 1:2425 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3218
Mailing Address - Country:US
Mailing Address - Phone:707-445-8121
Mailing Address - Fax:707-269-3782
Practice Address - Street 1:2425 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3218
Practice Address - Country:US
Practice Address - Phone:707-445-8121
Practice Address - Fax:707-269-3782
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065800Medicaid
CA00G460390Medicare ID - Type Unspecified