Provider Demographics
NPI:1093551517
Name:DR. PINOCCHIO OTD INC., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR. PINOCCHIO OTD INC., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINOCCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-984-4204
Mailing Address - Street 1:3685 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5280
Mailing Address - Country:US
Mailing Address - Phone:775-360-3206
Mailing Address - Fax:775-490-3001
Practice Address - Street 1:3685 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5280
Practice Address - Country:US
Practice Address - Phone:775-360-3206
Practice Address - Fax:775-490-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty