Provider Demographics
NPI:1013203124
Name:JESUS S PINEDA M.D.P.A.
Entity Type:Organization
Organization Name:JESUS S PINEDA M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:S
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-727-0849
Mailing Address - Street 1:10604 KIRBY DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8471
Mailing Address - Country:US
Mailing Address - Phone:956-727-0849
Mailing Address - Fax:956-712-2281
Practice Address - Street 1:201 W DEL MAR BLVD
Practice Address - Street 2:7A
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2240
Practice Address - Country:US
Practice Address - Phone:956-727-0849
Practice Address - Fax:956-712-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135390604Medicaid
TX00U03CMedicare PIN