Provider Demographics
NPI:1134182264
Name:PINNA, CHARISMA O (MD)
Entity type:Individual
Prefix:
First Name:CHARISMA
Middle Name:O
Last Name:PINNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S 300 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3900
Mailing Address - Country:US
Mailing Address - Phone:435-688-8413
Mailing Address - Fax:435-673-4045
Practice Address - Street 1:515 S 300 E
Practice Address - Street 2:SUITE 101
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3900
Practice Address - Country:US
Practice Address - Phone:435-688-8413
Practice Address - Fax:435-673-4045
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT55256331205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT55256331200001OtherBLUE CROSS
UT51216OtherPEHP
UTP00275005OtherRAILROAD MEDICARE
UT2300148OtherUNITED HEALTH CARE
UT233290OtherALTIUS
UT7509310OtherAETNA
UT55256331200001OtherBLUE CROSS
UT005784601Medicare ID - Type Unspecified