Provider Demographics
NPI:1083441638
Name:PINEDA, ERVIN
Entity type:Individual
Prefix:
First Name:ERVIN
Middle Name:
Last Name:PINEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E OCEAN BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-5052
Mailing Address - Country:US
Mailing Address - Phone:323-872-0663
Mailing Address - Fax:
Practice Address - Street 1:555 E OCEAN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-5052
Practice Address - Country:US
Practice Address - Phone:323-872-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
150112106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist