Provider Demographics
NPI:1376268193
Name:PINEDO, MAIRA (BA)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:
Last Name:PINEDO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20163 LIVORNO WAY
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4090
Mailing Address - Country:US
Mailing Address - Phone:818-462-3926
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3322
Practice Address - Country:US
Practice Address - Phone:818-895-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker