Provider Demographics
NPI:1760573521
Name:PINEDA, MARILYN ALTAGRACIA (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ALTAGRACIA
Last Name:PINEDA
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:216 STREET HA-45
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:786-374-1876
Mailing Address - Fax:787-257-1577
Practice Address - Street 1:216 STREET HA-45
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:786-374-1876
Practice Address - Fax:787-257-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16513208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16513OtherSTATE LICENSE