Provider Demographics
NPI:1750859997
Name:PINEDA, JERICHO C
Entity Type:Individual
Prefix:
First Name:JERICHO
Middle Name:C
Last Name:PINEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 S 500 W
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7433
Mailing Address - Country:US
Mailing Address - Phone:801-406-9002
Mailing Address - Fax:801-855-5660
Practice Address - Street 1:1576 S 500 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7433
Practice Address - Country:US
Practice Address - Phone:801-406-9002
Practice Address - Fax:801-855-5660
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10998714-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical