Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 213000323 | IL |
Y | 222Z00000X | Podiatrist | 213000323 | IL |
N | 224P00000X | Prosthetist | 211000325 | IL |
NPI | 1417518358 |
---|---|
Provider Name | Jaime Perez Pineda |
First Address | Riverside, CA 92505-8509 |
Second Address | Riverside, CA 92505-8509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 21/06/2019 |