Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003390386 |
---|---|
Provider Name | Oscar Pineda |
First Address | Long Beach, CA 90814-1001 |
Second Address | Long Beach, CA 90814-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2018 |
Last Update Date | 21/09/2018 |