Provider Demographics
NPI:1760587950
Name:PINEDA, ROSIE BLAS (MS)
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:BLAS
Last Name:PINEDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ROSIE
Other - Middle Name:BLAS
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 2196
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-2196
Mailing Address - Country:US
Mailing Address - Phone:626-963-2856
Mailing Address - Fax:626-914-9416
Practice Address - Street 1:2990 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764
Practice Address - Country:US
Practice Address - Phone:909-980-3427
Practice Address - Fax:909-945-3426
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38716101YM0800X
CAMFC38716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA297851400Medicare UPIN