Provider Demographics
NPI:1487010625
Name:PINEDA, BERWYN (PTA)
Entity Type:Individual
Prefix:
First Name:BERWYN
Middle Name:
Last Name:PINEDA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 VENTURA BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4604
Mailing Address - Country:US
Mailing Address - Phone:800-952-1290
Mailing Address - Fax:
Practice Address - Street 1:16260 VENTURA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4604
Practice Address - Country:US
Practice Address - Phone:800-952-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8946225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant