Provider Demographics
NPI:1194177782
Name:PINEDO, RYAN (DPM)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:PINEDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 E MCDOWELL RD STE 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2500
Mailing Address - Country:US
Mailing Address - Phone:602-340-8686
Mailing Address - Fax:602-340-8061
Practice Address - Street 1:926 E MCDOWELL RD STE 121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2500
Practice Address - Country:US
Practice Address - Phone:602-340-8686
Practice Address - Fax:602-340-8061
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10383566-0501213E00000X
AZPOD-001015213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty