Provider Demographics
NPI:1669467148
Name:PINTELON, LYN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:LYN
Middle Name:MARIE
Last Name:PINTELON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 GARFIELD ST
Mailing Address - Street 2:STE 6
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3922
Mailing Address - Country:US
Mailing Address - Phone:951-358-0784
Mailing Address - Fax:951-354-7583
Practice Address - Street 1:8990 GARFIELD ST
Practice Address - Street 2:STE 6
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3922
Practice Address - Country:US
Practice Address - Phone:951-358-0784
Practice Address - Fax:951-354-7583
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX73080Medicaid
CA00AX73080Medicaid
X76211Medicare UPIN