Provider Demographics
NPI:1972290526
Name:PINILLA, ALVARO (PA)
Entity type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:PINILLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:636 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5005
Mailing Address - Country:US
Mailing Address - Phone:832-818-6247
Mailing Address - Fax:
Practice Address - Street 1:1141 E GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5316
Practice Address - Country:US
Practice Address - Phone:328-186-2478
Practice Address - Fax:602-229-8560
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ10333363AM0700X
PR1636-P-A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical