Provider Demographics
NPI:1093352213
Name:PINEDA, ATRIK MARLENE
Entity Type:Individual
Prefix:
First Name:ATRIK
Middle Name:MARLENE
Last Name:PINEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PROGRESS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-3510
Mailing Address - Country:US
Mailing Address - Phone:401-644-0441
Mailing Address - Fax:
Practice Address - Street 1:110 PROGRESS AVE FL 2
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-3510
Practice Address - Country:US
Practice Address - Phone:401-644-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISB870OtherBLUE CROOS RI
RIES01788Medicaid
RI0614OtherNHP RI