Provider Demographics
NPI:1417518358
Name:PEREZ PINEDA, JAIME (CPO)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:PEREZ PINEDA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 RIVERWALK PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8509
Mailing Address - Country:US
Mailing Address - Phone:951-637-6586
Mailing Address - Fax:
Practice Address - Street 1:4244 RIVERWALK PKWY STE 180
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8509
Practice Address - Country:US
Practice Address - Phone:951-637-6586
Practice Address - Fax:844-447-5895
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000323222Z00000X
IL211000325224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist