Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0436606 | KS |
N | 208D00000X | General Practice Physician | 0436606 | KS |
NPI | 1700920832 |
---|---|
Provider Name | Dr. Romeo Miraflor Pineda JR. |
First Address | Olathe, KS 66062-1744 |
Second Address | Olathe, KS 66062-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 02/11/2018 |