Provider Demographics
NPI:1689344848
Name:PIEDAD, ROGER TIMOTHY ALONA (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:ROGER TIMOTHY
Middle Name:ALONA
Last Name:PIEDAD
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 166TH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1501
Mailing Address - Country:US
Mailing Address - Phone:562-316-4022
Mailing Address - Fax:
Practice Address - Street 1:10803 166TH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1501
Practice Address - Country:US
Practice Address - Phone:562-316-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018401363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health