Provider Demographics
NPI:1508905191
Name:PINEDO, BETZAIDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETZAIDA
Middle Name:
Last Name:PINEDO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:PINEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2637 N 64TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-1528
Mailing Address - Country:US
Mailing Address - Phone:602-242-0281
Mailing Address - Fax:602-242-2791
Practice Address - Street 1:4510 N 37TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-3206
Practice Address - Country:US
Practice Address - Phone:602-242-0281
Practice Address - Fax:602-242-2791
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN116229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ814071OtherAHCCCS