Provider Demographics
NPI:1255490231
Name:LUIGI C. PACINI M.D. INC.
Entity type:Organization
Organization Name:LUIGI C. PACINI M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-464-7757
Mailing Address - Street 1:1307 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1012
Mailing Address - Country:US
Mailing Address - Phone:209-464-7757
Mailing Address - Fax:209-464-7761
Practice Address - Street 1:1307 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1012
Practice Address - Country:US
Practice Address - Phone:209-464-7757
Practice Address - Fax:209-464-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4367OtherMEDICAL LICENSE
CAE08757Medicare UPIN
CA20A4367OtherMEDICAL LICENSE