1932744851 NPI number — MS. PINENIECE JOSHUA BA, MA GRAD PROGRAM

Table of content: MS. PINENIECE JOSHUA BA, MA GRAD PROGRAM (NPI 1932744851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932744851 NPI number — MS. PINENIECE JOSHUA BA, MA GRAD PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOSHUA
Provider First Name:
PINENIECE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BA, MA GRAD PROGRAM
Provider Gender Code:
F

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:
1932744851
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6666 GREEN VALLEY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CULVER CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90230-7068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-305-8878
Provider Business Mailing Address Fax Number:
310-846-5278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6666 GREEN VALLEY CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90230-7068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-846-5270
Provider Business Practice Location Address Fax Number:
310-846-4089
Provider Enumeration Date:
11/14/2019

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: 171M00000X , 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)





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