Provider Demographics
NPI:1588091144
Name:PIPINOS, STEPHANIA (NCBTMB)
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:PIPINOS
Suffix:
Gender:F
Credentials:NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 NICKEL AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-9134
Mailing Address - Country:US
Mailing Address - Phone:707-954-1812
Mailing Address - Fax:
Practice Address - Street 1:2522 NICKEL AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-9134
Practice Address - Country:US
Practice Address - Phone:707-954-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist