Provider Demographics
NPI:1659509297
Name:PINUELAS, CARMEN M (RDHAP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:PINUELAS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17464 RUNNYMEDE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2433
Mailing Address - Country:US
Mailing Address - Phone:323-351-7420
Mailing Address - Fax:
Practice Address - Street 1:17464 RUNNYMEDE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2433
Practice Address - Country:US
Practice Address - Phone:323-351-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP#243124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist