Provider Demographics
NPI:1962057158
Name:PINEDA, IRIS (SA-C)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:PINEDA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 WOODLAND CT
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5465
Mailing Address - Country:US
Mailing Address - Phone:817-305-1057
Mailing Address - Fax:
Practice Address - Street 1:837 WOODLAND CT
Practice Address - Street 2:
Practice Address - City:KENNEDALE
Practice Address - State:TX
Practice Address - Zip Code:76060-5465
Practice Address - Country:US
Practice Address - Phone:817-305-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19-318246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant