Provider Demographics
NPI:1699360651
Name:PINEDA, KAYLA RAE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:PINEDA
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 1:7132 BANDERA RD UNIT 36
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1276
Mailing Address - Country:US
Mailing Address - Phone:830-275-0451
Mailing Address - Fax:
Practice Address - Street 1:7428 W MILITARY DR STE D
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-3010
Practice Address - Country:US
Practice Address - Phone:210-673-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352895164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse