Provider Demographics
NPI:1649750068
Name:PINA, SIMONA
Entity Type:Individual
Prefix:MISS
First Name:SIMONA
Middle Name:
Last Name:PINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 GRAND CANAL BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8260
Mailing Address - Country:US
Mailing Address - Phone:209-954-3000
Mailing Address - Fax:209-957-8876
Practice Address - Street 1:2575 GRAND CANAL BLVD STE 330
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8260
Practice Address - Country:US
Practice Address - Phone:209-954-3000
Practice Address - Fax:209-957-8876
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker