Provider Demographics
NPI:1225850720
Name:O PINEDA, ERIC LEE (PTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:O PINEDA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 BALBOA BLVD STE 242
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3593
Mailing Address - Country:US
Mailing Address - Phone:877-757-8353
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 242
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3593
Practice Address - Country:US
Practice Address - Phone:877-757-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50778225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant