Provider Demographics
NPI:1184171290
Name:PINNICALE PAIN CENTER
Entity type:Organization
Organization Name:PINNICALE PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:509-388-3388
Mailing Address - Street 1:80 HOYT LANE
Mailing Address - Street 2:
Mailing Address - City:WAPATO
Mailing Address - State:WA
Mailing Address - Zip Code:98951-9753
Mailing Address - Country:US
Mailing Address - Phone:509-388-3388
Mailing Address - Fax:
Practice Address - Street 1:3730 PLAZA WAY STE C6100
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2718
Practice Address - Country:US
Practice Address - Phone:509-591-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty