Provider Demographics
NPI:1215521463
Name:PINEDA, MARIA DR
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DR
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 1:29450 SE LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:BORING
Mailing Address - State:OR
Mailing Address - Zip Code:97009-7429
Mailing Address - Country:US
Mailing Address - Phone:510-676-1275
Mailing Address - Fax:
Practice Address - Street 1:29450 SE LARIAT LN
Practice Address - Street 2:
Practice Address - City:BORING
Practice Address - State:OR
Practice Address - Zip Code:97009-7429
Practice Address - Country:US
Practice Address - Phone:510-676-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495084163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1763248-96OtherOCCUPATIONAL HEALTH CLINIC