Provider Demographics
NPI:1336773811
Name:BURBANO PIMENTLE, MARIA DANIELA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DANIELA
Last Name:BURBANO PIMENTLE
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:1040 FLYNN RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5092
Mailing Address - Country:US
Mailing Address - Phone:805-673-3930
Mailing Address - Fax:805-659-3217
Practice Address - Street 1:1424 MADERA RD
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3053
Practice Address - Country:US
Practice Address - Phone:805-522-5722
Practice Address - Fax:805-915-4141
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-09-28
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Provider Licenses
StateLicense IDTaxonomies
CAPA58245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant