Provider Demographics
NPI:1902102874
Name:PIMIENTA MEDICAL DIAGNOSTICS CLINIC PLC
Entity Type:Organization
Organization Name:PIMIENTA MEDICAL DIAGNOSTICS CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIMIENTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-323-2073
Mailing Address - Street 1:2330 N ROSEMONT BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2163
Mailing Address - Country:US
Mailing Address - Phone:520-323-2073
Mailing Address - Fax:520-323-1166
Practice Address - Street 1:2330 N ROSEMONT BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2163
Practice Address - Country:US
Practice Address - Phone:520-323-2073
Practice Address - Fax:520-323-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717259Medicaid
AZH74794Medicare UPIN