Provider Demographics
NPI:1164684734
Name:PINEDA ANZUETO, CARLOS EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:PINEDA ANZUETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2156
Mailing Address - Country:US
Mailing Address - Phone:650-799-2967
Mailing Address - Fax:
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-545-7272
Practice Address - Fax:901-545-8292
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1152112086S0129X
WAMD608709702086S0129X
WI3048-3202086S0129X
TN695142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery