Provider Demographics
NPI:1174052435
Name:EDUARDO PINEDA MD, INC
Entity type:Organization
Organization Name:EDUARDO PINEDA MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OFFIR
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAFANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-256-4175
Mailing Address - Street 1:820 N MOUNTAIN AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N MOUNTAIN AVE STE 108
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4163
Practice Address - Country:US
Practice Address - Phone:909-256-4175
Practice Address - Fax:909-727-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53030261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health