Provider Demographics
NPI:1295538585
Name:PIGNOTTI, MARY ROSE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:PIGNOTTI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CONCOURS
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4875
Mailing Address - Country:US
Mailing Address - Phone:909-240-1764
Mailing Address - Fax:
Practice Address - Street 1:3333 CONCOURS
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4875
Practice Address - Country:US
Practice Address - Phone:909-240-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician