Provider Demographics
NPI:1750505061
Name:PINYASONE, BOUNMY - (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:BOUNMY
Middle Name:-
Last Name:PINYASONE
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 N. CLARK STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2124
Mailing Address - Country:US
Mailing Address - Phone:559-528-0565
Mailing Address - Fax:559-528-0567
Practice Address - Street 1:141 N. CLARK STREET
Practice Address - Street 2:SUITE A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-528-0565
Practice Address - Fax:559-528-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15674363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical