Provider Demographics
NPI:1740314897
Name:PICCHIONE, PASQUALE V (MD)
Entity type:Individual
Prefix:
First Name:PASQUALE
Middle Name:V
Last Name:PICCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:968 N AVENIDA OLIVOS
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5744
Mailing Address - Country:US
Mailing Address - Phone:760-325-9455
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:968 N AVENIDA OLIVOS
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5744
Practice Address - Country:US
Practice Address - Phone:760-323-9455
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30135207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34126Medicare UPIN