Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 254368 | MA |
NPI | 1154501484 |
---|---|
Provider Name | Dr. Carol Pineda |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2007 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254368 | MA LICENSE (01) | MA |