Provider Demographics
NPI:1972768844
Name:PIGNONE, MARIAH (PA)
Entity Type:Individual
Prefix:MISS
First Name:MARIAH
Middle Name:
Last Name:PIGNONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 1/2 W OLYMPIC BLVD
Mailing Address - Street 2:4560 ADMIRAL WAY, SUITE 303, MARINA DEL REY, CA 9002
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5330
Mailing Address - Country:US
Mailing Address - Phone:323-935-3270
Mailing Address - Fax:
Practice Address - Street 1:12756 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-1626
Practice Address - Country:US
Practice Address - Phone:818-896-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical