Provider Demographics
NPI:1154574242
Name:PIERRE MEDICAL CORP
Entity type:Organization
Organization Name:PIERRE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RENDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-496-9190
Mailing Address - Street 1:325 ROLLING OAKS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1286
Mailing Address - Country:US
Mailing Address - Phone:805-496-9190
Mailing Address - Fax:805-496-9185
Practice Address - Street 1:325 ROLLING OAKS DR STE 130
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1286
Practice Address - Country:US
Practice Address - Phone:805-496-9190
Practice Address - Fax:805-496-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66363207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H30926Medicare UPIN