Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043594682 |
---|---|
Provider Name | Michael Pineda |
First Address | Huntington Park, CA 90255-4119 |
Second Address | Huntington Park, CA 90255-4119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 30/04/2021 |