Provider Demographics
NPI:1669571410
Name:PINO, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:PINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:M
Other - Last Name:PINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26922 OSO PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5800
Mailing Address - Country:US
Mailing Address - Phone:949-282-1065
Mailing Address - Fax:949-282-0015
Practice Address - Street 1:26922 OSO PKWY STE 380
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-282-1065
Practice Address - Fax:949-282-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG34344OtherCA. STATE LICENCE
CAG34344OtherCA. STATE LICENCE