Provider Demographics
NPI:1982463469
Name:BIONDIN, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BIONDIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79125
Mailing Address - Street 2:PO BOX 5582 CORPORATE CENTER DRIVE
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-5582
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:
Practice Address - Street 1:79125
Practice Address - Street 2:PO BOX 5582 CORPORATE CENTER DRIVE
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92248-5582
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant