Provider Demographics
NPI:1215999123
Name:PINILLOS, HUGO L (MD)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:L
Last Name:PINILLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13657 W MCDOWELL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2601
Mailing Address - Country:US
Mailing Address - Phone:623-935-4056
Mailing Address - Fax:623-935-2018
Practice Address - Street 1:13657 W MCDOWELL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2601
Practice Address - Country:US
Practice Address - Phone:623-935-4056
Practice Address - Fax:623-935-2018
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32118207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ837536Medicaid
AZ80300Medicare ID - Type Unspecified
AZ837536Medicaid