Provider Demographics
NPI:1760254015
Name:MANCIA PINEDA, JUDITH AMANDA
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:AMANDA
Last Name:MANCIA 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 1:4215 BLUE RIDGE CUT OFF
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1420
Mailing Address - Country:US
Mailing Address - Phone:360-903-8168
Mailing Address - Fax:
Practice Address - Street 1:4215 BLUE RIDGE CUT OFF
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1420
Practice Address - Country:US
Practice Address - Phone:360-903-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist