Provider Demographics
NPI:1689966244
Name:PINGATORE, CARMELLA JULIETTE (LAC, MSTOM)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:JULIETTE
Last Name:PINGATORE
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3594 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5017
Mailing Address - Country:US
Mailing Address - Phone:619-549-4653
Mailing Address - Fax:
Practice Address - Street 1:3594 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5017
Practice Address - Country:US
Practice Address - Phone:619-549-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist