Provider Demographics
NPI:1770618605
Name:PILLINER, JEANETTE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:NICOLE
Last Name:PILLINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18309 LAKEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0253
Mailing Address - Country:US
Mailing Address - Phone:323-253-5317
Mailing Address - Fax:
Practice Address - Street 1:729 HUDSPETH ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-5505
Practice Address - Country:US
Practice Address - Phone:323-253-5317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72590208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A725900Medicaid
CAW11698OtherGROUP ID
CAHAP70436FMedicaid
CAEAP70436FMedicaid
CAFHC70436FMedicaid
CAEAP70436FMedicaid