Provider Demographics
NPI:1083422943
Name:PINIAZ, BARTLOMIEJ DANIAL (CBC)
Entity type:Individual
Prefix:
First Name:BARTLOMIEJ
Middle Name:DANIAL
Last Name:PINIAZ
Suffix:
Gender:M
Credentials:CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-0270
Mailing Address - Country:US
Mailing Address - Phone:904-502-2610
Mailing Address - Fax:
Practice Address - Street 1:340 AMELIA CT
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7658
Practice Address - Country:US
Practice Address - Phone:904-502-2610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBC1255280171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications