1396865333 NPI number — MR. HECTOR NARCISO PINEDA PA-C

Table of content: JORDAN RASNER PTA (NPI 1386034585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396865333 NPI number — MR. HECTOR NARCISO PINEDA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINEDA
Provider First Name:
HECTOR
Provider Middle Name:
NARCISO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396865333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4207 SLAUSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90270-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-560-1100
Provider Business Mailing Address Fax Number:
323-560-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15718 PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-4352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-634-2111
Provider Business Practice Location Address Fax Number:
562-634-2112
Provider Enumeration Date:
03/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA17156 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA17156 . This is a "PA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com