Provider Demographics
NPI:1841247137
Name:PRESSIMONE, JOAN MARIE (PA)
Entity type:Individual
Prefix:
First Name:JOAN MARIE
Middle Name:
Last Name:PRESSIMONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOAN MARIE
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4155
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-8155
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:
Practice Address - Street 1:5555 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-416-6585
Practice Address - Fax:626-623-1227
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008359363A00000X
CAPA54423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP52849Medicare UPIN
NY5F0951Medicare PIN