Provider Demographics
NPI:1629599188
Name:PINA, MAYRA ALEXANDRA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEXANDRA
Last Name:PINA
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 38TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2027
Mailing Address - Country:US
Mailing Address - Phone:646-915-7036
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:212-564-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist