Provider Demographics
NPI:1376665760
Name:PINA, GREGORIO (PH D)
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:
Last Name:PINA
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S COL ROWE BLVD STE B9
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2954
Mailing Address - Country:US
Mailing Address - Phone:956-687-7004
Mailing Address - Fax:956-687-7014
Practice Address - Street 1:1200 S COL ROWE BLVD STE B9
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2954
Practice Address - Country:US
Practice Address - Phone:956-687-7004
Practice Address - Fax:956-687-7014
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist